EMT Training Vital Signs (Ch. 13)

Which assessment are vitals signs a part of? What are the assessments?

Vital signs are a part of the secondary assessment

The primary assessment is finding and solving immediate threats to life.

The secondary assessment is more thorough, gathering additional information including vital signs to guide ongoing care.

Where do you take pulse for patients?

For patients younger than 1 year you take their brachial pulse

For patients 1 year and older you take their radial pulse.

If you can’t:

1. Try the other arm

2. Use the carotid pulse, but only one side at a time and don’t use excessive pressure.

What are the things we are concerned with when it comes to pulse?

1. Pulse Rate

   1. Beats per minute.

   2. Normally is 60-100, but athletes can have 40-50 and it be normal.

   3. People tend to have high pulses during emergencies, try taking it multiple times and if it stays above 120 or below 50 then you can consider something wrong.

2. Pulse Quality

   1. Rhythm

   Are the intervals between beats constant?

   1. Force

   Does the pulse feel weak/thin?

What is a weak pulse known as?

Thready pulse

What fingers do we use for the radial pulse and why?

We use three fingers pointer to ring.

We do not use thumb because it can cause us to take our own pulse.

Respiratory Rate and Rhythm. How should the rate be taken?

The normal rate is 12-20, but can be influenced by many factors.

The Respiratory Rhythm of conscious patients doesn’t matter, but for unconscious it should be considered.

Since people breathe differently when being observed we should observe the breathing rate whenever we are also taking the pulse rate.

What are the 4 categories of respiratory quality?

1. Normal, doesn’t use other muscles to assist breathing and intense noise.

2. Shallow, only slight movement of the chest and abdomen. Important to note that many breathe more with diaphragm when resting.

3. Labored, using their accessory muscles. Common wiht little kids to see retractions around the collar bones and between the ribs.

4. Noisy. Noise and what to do.

   1. Snoring. Open Airway.

   2. Wheezing. Medication.

   3. Gurgling. Provide suction.

   4. Crowing. Refers to a sound called Stridor. Noisy sounds like obstructed airway. In this case bring to hospital.

Where are the best places to assess skin color?

For most, the nail beds, insides of cheeks, and insides of lower eye lids.

For children their hands and soles.

For darker skinned patients on their lips and nail beds.

What are the abnormal colors of skin?

1. Pale

2. Cyanotic (blue-gray)

3. Flushed (Exposure to heat)

4. Jaundiced (Liver problems)

5. Mottling (Botchy appearance, sign of shock)

Initial Temperature and Moisture

Feel forehead with back of hand. Feel for moisture at the same time. If it feels cold then feel the abdomen beneath clothing.

Also look for gossebumps, these are a sign of chills.

What does Clammy mean?

Clammy means both cool and moist.

What do we look out for when examining pupils

1. Size (is it appropriate for the light?)

2. Equality (same rate? And does one constrict when the other has light?)

3. Reactivity (does it respond to light?)

In bright environments, close their eyes before opening and shining the light.

What are the levels of blood pressure that are hypertension, prehypertension, and seriously low?

What do we measure blood pressure with?

Hypertension: 140/90 or higher

Prehypertension: Above 120/80

It’s seriously low when systolic is below 90 mmHg.

Measured with a sphygmomanometer

What are the methods used to find blood pressure?

Auscultation using a stethoscope

Palpation

Blood Pressure Monitoring Machine

What are the steps to getting blood pressure via ascultation?

How should they be rounded?

What do you do when you’re not certain about the result?

What are things which can make readings inaccurate?

What do you do differently for palpation?

1. Patient is seated/lying. Support arm level with heart

2. Position cuff, position diaphragm directly over brachial artery (or medial anterior elbow if that fails)

3. Inflate cuff to 30 higher than where pulse sound was heard

4. Lower till you hear the beat, this is systolic

5. Deflate until the sound turns into dull and muffled thuds

Record the measurements as even numbers rounded up.

If you aren’t certain then you must switch arms or wait a minute before trying again.

High systolic can make diastolic inaccurate so repeat in those cases.

Irregular heart beats lead to irregularly low readings, so you should deflate slowly.

For palpation you feel radial pulse, and you only take the systolic blood pressure.

How often should we check patients vital signs?

For stable patients we should check their vital signs every 15 minutes

For unstable patients every 5

We should repeat check after every medical intervention

And we should write each time to track changes,

Where is temperature measured?

Which thermometer do we use?

What does measuring temperature help us find?

Which thermometers are typically not accurate?

What’s the range of temperatures for healthy people?

Temperature is measured orally, rectally, or in the arm pit.

We use the electronic thermometer because the glass can shatter on bumpy roads.

Measuring temperature helps us screen for influenza.

Tympanic thermometers and forehead thermometers are not accurate

96.8-101.3 is the range for healthy people.

What is oxygen saturation measured by? What other thing measures the additional thing?

What is the abbreviation for oxygen saturation?

Measured by Pulse Oximeter measures oxygen saturation.

CO-Oximeters measure Carbon monoxide as well as oxygen.

The abbreviation is: SpO₂

What are the oxygen saturations identified as?

96-100 is Healthy

91-95 is Mild Hypoxia

86-90 is Moderate Hypoxia

85 or less is Severe Hypoxia

What are some cautions for pulse oximetry.

1. Inaccurate with shock, hypoxia, anemia, and hypovolemia

2. Inaccurate with carbon monoxide poison and chronic smokers.

3. Movements during reading and nail polish can make it inaccurate

4. Accuracy must be checked regularly, batteries must be good, probe must be clean.

5. Don’t rely solely on device readings

6. Make sure pulse rate matches, if it’s different then it’s inaccurate

What are some cases where we administer oxygen via nonrebreather

1. If the oxygen saturation is below 90

2. Exposure to carbon monoxide

3. Severe respiratory distress

In more mild cases we can administer low concentration oxygen via nasal cannula.

Where do we attach the pulse oximeter

Fingertips, toes, or distal foot in infants

Move it if you get a poor signal or trouble.

What are some things to consider before using blood glucose meters?

What are the steps to using a blood glucose meter?

What is the normal range?

You need medical direction to use them.

You can let the patient use their own blood glucose meter, but don’t use theirs as each is used differently.

1. Prepare test strip and lancet

2. Use alcohol to prep finger

3. After alcohol dries, use lancet to do finger stick. If needed squeeze, lower hand, or warm.

4. Apply blood to test strip

Normal is 70-100

What does Capnography measure and what does it tell us?

Describe how it works.

It measures ETCO₂ which stands for End Tidal Carbon Dioxide and is normally 35-45.

Tells us, indirectly, how well the tissues are using oxygen.

It works by taking a small amount of exhaled air through a small tube via a nasal cannula or out of ventilated exhaled air.