Vitals, Secondary, SMR

Week 3

Heart Rate/Pulse Rate

• Palpate for 10secs (x6)

• Rate, rhythm, volume

• Adequate cardiac output produces palpable pulses (CO = SV x HR)

• Normal: 60-100 bpm

• Tachycardia > 100 bpm

• Bradycardia < 50 bpm

Heart Rate/Pulse Rate Issues

• Make sure you’re not feeling your pulse

• Become confident in finding pulses

• Don’t cut off circulation

• If irregular hr, count 60 secs

Blood Pressure

Measures pressure exerted by blood against the arterial walls (mmHg)

Normotensive SBP > 100mmHg

Hypertensive SBP > 140mmHg

Hypotensive SBP < 90mmHg

Non-Invasive BP (NIBP)

Mean Arterial Pressure

Average pressure in arteries in cardiac cycle

MAP = CO x SVR (system vascular resistance: tightly arteries are squeezed)

MAP = 1/3 SBP x 2/3 DBP (70-110mmHg) (<60 mmHg affects organ perfusion)

Korotkoff Sounds

P1: Sharp Tapping

P2: Whooshing Sound

P3: Soft Thump

P4: Muffled Fading Sounds

P5: Silence

Blood Pressure Issues

Positioning, loud noises and movement

Respiratory Rate

• 15 secs (x4)

• Rate, rhythm, depth

• Normal: 12-20 breaths/min

• Tachypneic > 28 bpm

• Bradypneic < 10bpm

Respiratory Rate Issues

• Can’t see

• Change breathing pattern

Oxygen Saturation (SpO2)

• Red vs IR light absorption through periphery

• Measures haemoglobin % saturation

• Finger, toe, ear

• Aerobic cell metabolism

• Normal: 94-100%

• COPD: 88-92%

Oxygen Saturation (SpO2) Issues

• Nail polish (try sideways)

• Cold (inaccurate reading)

• Light (other light gets in) (use blanket)

• Motions (sometimes opens & closes)

• Dirty Hands (alcohol wipe)

• Fidget with it (blanket)

• Carbon Monoxide (CO makes high reading)

SpO2 Waveform

Normal Signal

SpO2 Waveform

Low Perfusion

SpO2 Waveform

Noise Artifact 

SpO2 Waveform

Motion Artifact

Temperature

• Tympanic (ear), oral (mouth), axillary (armpit), rectal (anus), infrared (forehead)

• Used for diseases and environmental illnesses

• Normal: 36-37 C

• Hyperthermic > 38 C (febrile)

• Hypothermic < 35 C

Temperature Issues

• Placement of tympanic

• Hearing aids increase temp (wait a few)

Blood Glucose Levels (BGL)

• Glucometer and test strip or finger prick (lancet)

• Ensure optimal levels of glucose in body

• Normal: 4-8mmol/L (different for diabetics 12-20 is normal)

• Hyperglycaemic > 18mmol/L

• Hypoglycaemic < 4mmol/L

Blood Glucose Levels (BGL) Issues

• Cold fingers (not enough blood)

• Use on side of finger (blood thinners)

• If just squeezing (run fingers down to encourage bloodflow)

• Wait for alcohol wipes to dry (get lower reading)

• Don’t clean fingers (higher reading)

• Glucometer doesn’t like cold

Glasgow Coma Scale (GCS)

• Access neurological function (what’s normal for them)

• Eyes (none, pain, verbal, spontaneous)

• Verbal (none, incomprehensible sounds, inappropriate words, confused, oriented)

• Motor (none, decerebrate, decorticate, withdraws from pain, localizes to pain, obeys commands)

Glasgow Coma Scale (GCS) Issues

Not suitable for people that are drunk, ods, not wanting to speak or dozing off

Pupils

• Access neurological function

• Size, equal, reactive, consensual

• PEARL (pupils are equal and reactive to light)

• Mydriasis (big ass pupils) (drugs, dead, dark areas)

• Miosis (small ass pupils) (opioids)

• Anisocoria (different sized pupils) (pressure on one side, ask if normal)

• Slow reaction/no reaction

Pupils Issues

• Light situations

• Shining in both eyes

ECG

• 3-Lead (4 stickers, 3 views of heart)

• 12-Lead (10 stickers, 12 views of heart)

• Check regularly and match pulses

ETCO2

• Capnography Line (measures CO2 levels during expiration)

• Levels of perfusion, ventilation, circulation, correlates PACO2 (Arterial CO2)

• Normal: 35-45mmHg

ETCO2 Issues

• Plug into machine before using on patient

• Fluid getting into tube

• Fidgeting

• Mouth breathing (use face mask)

Head & Neck

• Bones: Frontal, parietal, temporal, occipital, zygomatic, maxilla, mandible

• Hair can cover bleeding

• TMJ (open and close mouth)

• Check eyes oot near nose, csf (halo), oral cavity, drooling, swallowing

• Palpate larynx, move neck

Chest

• Palpate clavicles, sternum, anterior and lateral chest walls (symmetry) and subcutaneous emphysema

• Feel expansion during expiration

• 6-point auscultation

Abdomen

• Visualize

• Palpate all four quadrants, gentle then deep

• Flanks

• Percuss, lay finger over area and tap first knuckle

Pelvic Fracture

Pubic Rami Fracture

Pelvic Fracture

Straddle Fracture

Pelvic Fracture

Vertical Sheer (5-15%)

Pelvic Fracture

Lateral Compression Fracture (60-70%)

Pelvic Fracture

Anterior and Posterior Compression Fracture (15-20%)

Pelvis

• Treat for one, don’t hunt for one

• If no obvious injury gentle squeeze, only inspect genitals if needed

• Tenderness over lateral pelvis/hip joints (hip dislocations/Neck of

  femur fractures)

Legs

• Assess pedal pulse and ROM

• Look for shortening

Extremities

Assess CSM and look for left/right inequality

Back

• Palpate scapula, vertebrae and ribs on back

SMR

• C3/4/5 keeps you alive

• Use smr for seniors that fall from standing height

Pulses

Temporal (head), carotid (neck), apical (chest), brachial (arm), radial (wrist), femoral (groin), popliteal (behind knee), posterior tibial (ankle), pedal (foot)