Vital Signs Part II

Blood Pressure/MAP

Two pressures, one number to watch: perfusion

(MAP) mean arterial pressure

Average pressure driving blood to the organs

what is normal MAP

70-100 mmHg

MAP formula

MAP = (SBP + 2 x DBP) / 3

SBP - systolic blood pressure

DBP - Diastolic blood pressure

what is normal BP

Systolic < 120

AND

Diastolic > 80

What is elevated BP

Systolic: 120-129

AND

Diastolic: < 80

what is stage 1 Hypertension

Systolic: 130-139

OR

Diastolic: 80-89

what is stage 2 hypertension

Systolic: > or equal to 140

OR

Diastolic: > or equal to 90

what is hypotension

Hypotension: Below 90

why is hypotension dangerous

Hypotension is often a late sign of shock. Do not wait for it

Auscultation

The standard manual method for assessing blood pressure

What are the steps to auscultate BP

1. Seat or lie the patient with the arm supported at heart level. Expose the upper arm

2. Choose the correct cuff size (wraps around 80% of the arm)

3. wrap the cuff snuggly about 1 inch above the elbow - over the brachial artery

4. Feel the radial pulse and inflate until it disappears. Note that number

5. Place the stethoscope diaphragm over the brachial artery at the elbow crease

6. inflate to 20-30 mmHg above where the radial pulse disappeared

7. deflate slowly, about 2-3 mmHg per second

8. first tapping sound = systolic

9. sound disappears = diastolic

10. deflate fully. Record the reading, time, arm, and patient position

Palpation blood pressure

use when it is too loud to hear

• feel the radial pulse and inflate bp cuff until the pulse disappears

• deflate slowly; first pulse felt = systolic

• record as “110/P” → no diastolic

Automatic blood pressure

fastest and frees the hands

• less accurate with irregular rhythms, motion, shivering, or shock

• unexpected result? confirm manually

• get a manual baseline when possible

sources of error when assessing BP

• cuff too small; falsely HIGH

• cuff too large; falsely LOW

• Arm below heart level; falsely high

• deflating too fast: underestimates systolic

• cuff over clothing

SPO2 - Pulse Oximetry

How saturated is hemoglobin

What is the average pulse ox. for mostly healthy people

95-100%

When do you administer oxygen for SPO2 readings

most EMS protocols give oxygen when SpO2 is below 94% or the patient is in distress

how do you apply the pulse ox monitor

1) Place the probe on a warm finger (earlobe or toe is needed)

2) Remove dark nail polish or turn the probe sideways

3) Keep the hand still

4) wait for a steady waveform and confirm HR matches the pulse you feel

5) Record the reading and whether on room air or O2

When does SpO2 lie

• carbon monoxide: falsely normal or high

• poor perfusion, shock, cold hand

• patient movement or shivering

• nail polish, bright light

• always treat the patient, not the number

Capnography (EtCO2)

The CO2 in every exhaled breath

what is a normal Capnography reading

35-45 mmHg

what does capnopgraphy also show us

a breath-by-breath respiratory rate and waveform

How do we obtain capnography

• nasal cannula capnography on breathing patients (can deliver O2 too)

• in-line sensor between nasal/airway and BVM for assisted ventilation

• confirm a square-shaped waveform

• record number, rate, and waveform shape

what does a EtCO2 reading of >45 mmHg signify

hypoventilation, CO2 retention

COPD/Overdose

what does a ETCO2 reading of <35 mmHG signify

hyperventilation or poor perfusion (shock)

What does a sudden rise in ETCO2 during CPR signify

possible return of circulation (ROC)

What does a flatline ins ETCO2 signify

(No exhaled CO2 is reaching the monitor)

disconnected

apnea

dislodged airway

Blood Glucose

Check sugar on every altered pati

what is a normal blood glucose reading

70-99 mg/dL, normal fasting (no diabetes)

hypoglycemia

below 70mg/dL

hyperglycemia

well above normal; often > 250 with symptoms

What is the technique to assess blood glucose

1. BSl/gloves on - gather glucometer, test strip, lancet, alcohol prep, gauze, sharps container

2. Insert the strip and confirm the meter is ready (check strip expiration)

3. Clean the side of a fingertip with alcohol and let it dry completely

4. lance the side of the fingertip. Dispose of the lancet in the sharps immediately

5. Wipe the first drop if your protocol says to, then touch the strip to the next drop

6. Apply gauze, read and record the value and time

Temperature

reflects heat production vs heat loss

what is the typical normal temperature range

97-99 degrees *F

~98.6 to be exact

what is fever

100.4 (38 *C) or higher

what is Hypothermia

95 (35 *C) or lower