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Vitals and History Taking

Vitals and History Taking. Hillcrest Fire Training December, 2000. Where are we going?. What are vital signs? How do you take them? So, what’s normal? SAMPLE History. What are the vitals. They provide information about the status of a patient Breating (Respirations) Pulse Skin Pupils

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Vitals and History Taking

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  1. Vitals and History Taking Hillcrest Fire Training December, 2000

  2. Where are we going? • What are vital signs? • How do you take them? • So, what’s normal? • SAMPLE History

  3. What are the vitals • They provide information about the status of a patient • Breating (Respirations) • Pulse • Skin • Pupils • Blood Pressure

  4. Counting Respirations • Respiration is one inhalation and exhalation. • Determined by counting for 30 sec, and multiplying by 2. • A hand on the stomach/chest may help

  5. Normal Respirations • Adult 12-20/min • Child 15-30/min • Infant 25-50/min

  6. Respiration Quality • Normal • Shallow (low tidal volume) • Labored • Use of accessory muscles • Flaring • Tripod Breating • Noisy breathing

  7. Pulse • Determined by counting for 30 sec and multiplying by 2. • Irregular pulse counted for 60 sec. • Provides information about heart, blood volume and perfusion. • Taken at a pulse point • Don’t use your thumb

  8. Central Pulses Carotid Femoral Peripheral Pulses Radial Brachial (children under 1) Posterior Tibial, Dorsalis Pedis Common Pulse Points

  9. Pulse Quality • Normal • Bounding • Weak • Thready • Regular/Irregular

  10. Normal Pulse Rate • Adult 60-80/min • Child 80-120 • Infant 120-150

  11. Color Pink (Normal) Pale Cyanotic (Oxygen problems) Red (CO or heat problems) Yellow (Jaundice) Temperature Warm (Normal) Hot Cool Cold Condition Dry (Normal) Moist Skin

  12. Practice • Get pulse and respirations from at least two people • Try to get pulse from carotid, radial, and brachial pulse points

  13. Assessing Skin • Color assessed using lips, nail beds, inside of mouth, membranes of the eye • Pull back glove to determine temp and condition • In children under 6 capillary refill is useful for determining perfusion • Refill should take less than 2 seconds

  14. Pupils • Size • Constricted • Dilated • Equal/Unequal • Reactivity to light • Can check with pen light or by shielding eyes from light

  15. Blood Pressure • Taken with manual or automatic BP cuff • Can be taken by auscultation or palpation

  16. Key Terms • Systolic • Pressure when heart is pumping • Diastolic • Pressure when heart is at rest

  17. BP by Auscultation • Size using guides on cuff • Position on upper arm hoses pointing down • Inflate 30mmHg past pulse • Position stethoscope over brachial artery • Deflate • Note first sound and last sound • Record as systolic/diastolic (140/80)

  18. One last note on Vitals • First set of vitals is the baseline, you are interested in changes • On not sick patients, repeat every 15 minutes • On sick patients, repeat every 5 minutes • Treat patient, not the vital signs or the equipment

  19. BP by Auscultation • Size using guides on cuff • Position on upper arm hoses pointing down • Inflate 30mmHg past pulse • Position stethoscope over brachial artery • Deflate • Note first sound and last sound • Record as systolic/diastolic (140/80)

  20. BP by Palpation • Size using guides on cuff • Position on upper arm centered over brachial artery • Inflate 30mmHg past pulse • Deflate • Record point at which pulse returns • Record as Systolic/P (135/p)

  21. Male Systolic = 100+age until 50 Diastolic =60-90 Female Systolic=90+age until 50 Diastolic = 50-80 Normal Blood Pressure

  22. Practice • Get BP from two people • Try at least two techniques for obtaining BP • Auscultation, Palpation, or Automatic Cuff

  23. History Taking

  24. SAMPLE • Organized technique to obtain pertinent medical informaiton • Can obtain information from patient, family or bystanders • SAMPLE is an acronym

  25. SAMPLE • Signs/Symptoms • Allergies • Medications • Past Pertinent Medical Conditions • Last Oral Intake • Events Leading to Injury or Illness

  26. Signs/Symptoms • Signs – things you can see or hear • Symptoms – things the patient reports

  27. Allergies • Environmental and Medical allergies are important • Medic Alert tags are also useful

  28. Medications • Prescription and OTC • Including vitamins, herbal remedies • Birth Control Pills • Illicit Drugs • Always get a list of meds, or take them with • Home O2 rate is also important • What did you take, when, how much?

  29. Past Pertinent Medical History • Underlying medical problems • Recent visits to hospitals/doctors • Recent medical procedures • Recent accidents/falls/trauma • Medic Alert tags may be useful • Look for signs of medical equipment in the house

  30. Last Oral Intake • What, how much, when • Important for trauma patients, diabetics

  31. Events Leading to Call • Get as much information as you can • What happened, what were you doing • Has anything unusual happened? • If this is a chronic problem, what’s different this time?

  32. Final SAMPLE notes • Try to ask open ended questions (avoid yes/no questions) • Wait for the patient to respond • 5-10 seconds is not out of line • Note pertinent negatives • Write everything down

  33. Practice • Let’s go through a couple of scenarios

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