Chapter 13 - Vital Signs and Monitoring Devices

Vital Signs

Outward signs of what is going on inside the body

Pulse

Beats felt as heart pumps blood through arteries

Pulse Rate

Number of beats per minute

Tachycardia

resting pulse rate above 100bpm

bradycardia

any pulse rate below 60bpm

First set of Vital Signs are called…

Baseline vitals

A rapid, regular, and full pulse may signify…

Exertion, fright, fever, high BP, First stage of blood loss

Rapid regular and thready irregular pulse may signify…

Shock, later stages of blood loss, or abnormal electrical activity in the heart

Slow pulse may signify…

head injury, drugs, some poisons, some heart problems, lack of O² in Children

No pulse signifies…

clinical death or, if awake, person may have an LVAD

Pulse Quality

Rhythm (Regular/Irregular) and force (Strong/Weak) of pulse

Radial Pulse

Pulse felt at the wrist (side of thumb)

Brachial Pulse

Pulse felt in upper arm

Carotid Pulse

Pulse felt along the large carotid artery on either side of the neck

Respiration

Act of breathing

Respiration Rate

number of breaths taken in one minute

Snoring sounds during auscultation significance and intervention

Blocked airway, open patient’s airway - transport promptly

Wheezing sounds during auscultation significance and intervention

Medical problem such as asthma, assist patient in taking prescribed medications - transport promptly

Gurgling sounds during auscultation significance and intervention

Fluids in airway, suction airway - transport promptly

Crowing (harsh sound when inhaling) during auscultation significance and intervention

Medical problem that cannot be treated on scene - transport promptly

Respiratory Quality

Normal or abnormal (shallow, labored, or noisy) character of breathing

Signs of labored breathing

Increased work of breathing, use of accessory muscles, nasal flaring, retractions (pulling in) above clavicle or in the intercostal spaces; may also hear stridor (harsh, high pitched sound on inspiration), grunting on expiration, or gasping.

Noisy breathing

aka obstructed breathing; includes snoring, wheezing, gurgling, and crowing.

Respiratory Rhythm

Regular or irregular spacing of breaths

Pink skin color means…

Normal in light-skinned patients; normal at inner eyelids, lips, and nail beds of dark-skinned patients

Pale skin color means…

Constricted blood vessels; possibly resulting from shock, blood loss, hypotension, or emotional distress

Cyanotic skin color means…

Lack of O²; Results from inadequate breathing or heart function

Flushed skin color means…

Exposure to heat, emotional excitement

Jaundiced skin color means…

Abnormalities of the Liver

Mottled skin color means…

A patient may be in shock

Cool, Clammy skin significance

Sign of shock, Anxiety

Cold, Moist skin significance

Body is losing heat

Cold, Dry skin significance

Exposure to cold

Hot, Dry skin significance

High fever, heat exposure

Hot, Moist skin significance

High fever, heat exposure

Significance of “goose pimples” that are associated with shivering, chattering teeth, blue lips, pale skin

Chills, communicable disease, exposure to cold, pain, or fear

Pupil

Black center of the eye that take in light

Dilate

to get larger

Reactivity

Change in pupil size in reaction to light

Constirction

get smaller

Dilated pupil significance

Fright, blood loss, drugs, prescription eye drops

Constricted pupil significance

Drugs, Prescription eye drops

Unequal pupil significance

Stroke, head injury, eye injury, artificial eye, prescription eye drops

Lack of pupil reactivity significance

Drugs, lack of O² to the brain

High BP and its significance

systolic of 140 or greater, diastolic of 90 or greater; may indicate a medical condition, exertion, fright, emotional distress, or excitement

Low BP and its significance

Systolic lower than 90; May indicate a blood loss, late sign of shock, or an athlete or other person with normally low BP

Pre-Hypertension BP

121-139 / 81-89

Sphygmomanometer

Cuff and gauge used to measure BP

Brachial artery

Major artery of the arm

Ausculation

Listening

Palpation

Touching or feeling

Pulse Oximeter

Electronic device for determining amount of O² carried in the blood; may be known as oxygen saturation or SpO²

Oxygen Saturation (SpO²)

Ratio of the amount of oxygen present in the blood to the amount that could be carried, expressed as a percentage.

Mild hypoxia SpO²

91-95%

Significant / Moderate Hypoxia SpO²

86-90%

Severe Hypoxia SpO²

85% or less

Things that can cause inaccurate Pulse Ox. readings

Shock, hypothermia, carbon monoxide poisoning, Chronic Smoking, Excessive movement, nail polish, anemia, hypovolemia

Capnography

testing method that tells us indirectly how well tissues are using O² by measuring amount of CO² exhaled; aka End-Title CO² or ETCO²

The two ways ETCO² can be obtained

Special Nasal Cannula or a “collar” that is placed on a BVM device