Vital Signs and SAMPLE

When is SAMPLE used?

It is used during patient assessment to gather medical history, which is important for medical assessments and relevant for trauma patients

What does SAMPLE stand for?

• S - signs (what I see) and symptoms (what pt tells me)

• A - allergies

• M - medications (prescribed, OTC, herbal - what pt tells me)

• P - past medical history (important stuff: hospitalizations, chronic conditions, etc.)

• L - last oral intake (what pt ate and drank and when)

• E - events leading up to situation (e.g. when was the last time pt felt well)

What are the main vital signs?

• Pulse

• Respiration

• Pupils

• Skin (color, condition, temp)

What are vital signs and why are they important?

They are outward signs of what’s going on in a patient and help establish a trend in their conditions

Baseline of Vitals

The first set of vitals completed upon encountering a patient

What is pulse rate and how is it counted?

• Number of heartbeats per minute

• Palpate for 30 seconds and then multiply by 2 to obtain bpm

Normal pulse rate for adults at rest

60-100 bpm

Tachycardia

Above 100 bpm

Bradycardia

Under 60 bpm

What can be considered serious when discussing pulse rates?

Below 50 bpm

Above 120 bpm

Pulse Rhythm

It reflects the regularity of the pulse

• Pulse can be:

  1. regular (interval between beats are constant)

  2. irregular (interval between beats aren’t constant)

  3. regularly irregular (irregular pattern repeats in predictable way - beat beat pause beat beat pause)

Pulse quality

Reflects how strong the pulse is

1. Weak: is associated with other symptoms

2. Thready: is associated with an irregular rhythm

3. Strong: a regular pulse

4. Bounding: a pulse associated after a exercise session

How to check radial pulse?

Place index and middle finger on wrist below thumb

What are vital sign respirations?

The act of breathing in and out

What is measured when examining vital sign respirations?

Rate, quality, rhythm

Respiratory rate/quality

1. Normal: Quiet, regular, effortless breathing with even chest rise

2. Shallow: Weak, light breathing with minimal chest movement

3. Labored: Breathing that requires extra effort — may include use of neck muscles, nasal flaring, or gasping

What’s a normal respiratory rate for adults at rest?

12-20 breaths per min

Tachypnea

24+ breaths per min

Bradypnea

>12 breaths per min

How to count vital sign respirations?

• In and out counts as 1 breath*

• Count number of breaths for 30 sec and multiply

Skin color metrics

• Pink (Normal)

• Pale

• Cyanotic (Oxygen problems)

• Red (CO or heat problems)

• Yellow (Jaundice)

Skin temperature metrics

• Warm (Normal)

• Hot

• Cool

• Cold

Skin condition metrics

• Dry (Normal)

• Moist

Assessing Pupils

Good pupils are PERRLA (Pupils Equal, Round, Reactive to Light, Accommodation)

• Pupils constrict when you shine light into it

• Pupils dilate when you take light away from it

Anisocoria (pupils uneven in size)

Blood pressure

Measure in millimeters of mercury of systolic and diastolic pressure

Systolic blood pressure

• The pressure in arteries when the heart contracts

• Occurs during systole (left ventricle pumps blood)

• Represents the maximum arterial pressure

• It's the top number in a BP reading
  (e.g., 120/80 → 120 is systolic)

• SQUEEZE = SYSTOLIC

Diastolic blood pressure

• The pressure in arteries when the heart relaxes

• Occurs during diastole (ventricles fill with blood)

• Represents the minimum arterial pressure

• It's the bottom number in a BP reading
  (e.g., 120/80 → 80 is diastolic)

• DOWN TIME = DIASTOLIC

Systole

The time at which ventricular contraction occurs

Number for systolic pressure

120 mmHg is the perfect number

• Female: 90 + age til 40

• Male: 100 + age til 40

Number for diastolic pressure

• 60-90 mmHg

• 80 mmHg is the perfect number

Placement of blood pressure cuff

• Wrap cuff around pts upper arm

• Lower edge of cuff placed about 1 inch above crease of elbow

• Center of bladder (bag) placed over brachial artery

What are two ways to measure blood pressure?

• Auscultation: listening over the brachial artery

• Palpation: to feel the radial pulse while using the BP cuff to determine systolic pressure only

Auscultation Method

• Position the cuff properly

• Palpate brachial artery at crease of elbow and place your stethoscope there

• Inflate cuff until you don't hear a brachial pulse

• Slowly deflate the cuff 10 pts. 3 seconds

• systolic (once return of pulse is heard)

• diastolic (once there is no sound)

Palpation Method

• Bp cuff is placed in the same place as in Auscultation

• Inflate cuff, until radial pulse disappears

• Continue to inflate another 20 points

• Now slowly deflate cuff 10 pts in 3 sec.

• Result: systolic pressure/P