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

Blood Pressure

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

Normal Respirations

Adult 12-20/min

Child 15-30/min

Infant 25-50/min

Respiration Quality

Normal

Shallow (low tidal volume)

Labored Use of accessory musclesFlaringTripod Breating

Noisy breathing

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

Common Pulse Points

Central Pulses Carotid Femoral

Peripheral Pulses Radial Brachial (children

under 1) Posterior Tibial,

Dorsalis Pedis

Pulse Quality

Normal

Bounding

Weak

Thready

Regular/Irregular

Normal Pulse Rate

Adult 60-80/min

Child 80-120

Infant 120-150

Skin

Color Pink (Normal) Pale Cyanotic (Oxygen

problems) Red (CO or heat

problems) Yellow (Jaundice)

Temperature Warm (Normal) Hot Cool Cold

Condition Dry (Normal) Moist

Practice

Get pulse and respirations from at least two people

Try to get pulse from carotid, radial, and brachial pulse points

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 perfusionRefill should take less than 2 seconds

Pupils

SizeConstrictedDilatedEqual/Unequal

Reactivity to lightCan check with pen light or by shielding eyes from light

Blood Pressure

Taken with manual or automatic BP cuff

Can be taken by auscultation or palpation

Key Terms

Systolic Pressure when heart

is pumping

Diastolic Pressure when heart

is at rest

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)

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

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)

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)

Normal Blood Pressure

Male Systolic = 100+age

until 50 Diastolic =60-90

Female Systolic=90+age

until 50 Diastolic = 50-80

Practice

Get BP from two people

Try at least two techniques for obtaining BP Auscultation,

Palpation, or Automatic Cuff

History Taking

SAMPLE

Organized technique to obtain pertinent medical informaiton

Can obtain information from patient, family or bystanders

SAMPLE is an acronym

SAMPLE

Signs/Symptoms

Allergies

Medications

Past Pertinent Medical Conditions

Last Oral Intake

Events Leading to Injury or Illness

Signs/Symptoms

Signs – things you can see or hear

Symptoms – things the patient reports

Allergies

Environmental and Medical allergies are important

Medic Alert tags are also useful

Medications

Prescription and OTC Including vitamins, herbal remedies

Birth Control PillsIllicit DrugsAlways get a list of meds, or take them with

Home O2 rate is also importantWhat did you take, when, how much?

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

Last Oral Intake

What, how much, when

Important for trauma patients, diabetics

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?

Final SAMPLE notes

Try to ask open ended questions (avoid yes/no questions)

Wait for the patient to respond5-10 seconds is not out of line

Note pertinent negatives

Write everything down

Practice

Let’s go through a couple of scenarios