CH. 11 Vital Signs, Monitoring Devices, and History Taking Key terms. Prehospital Emergency Care, 12e

Auscultation

key technique used in medical examinations to listen to the internal sounds of the body, particularly breath sounds.

Baseline Vital Signs

the first set of measurements taken, initial reading of basic signs of life, including body temperature, pulse, blood pressure, and respiration rate

Blood Pressure - BP

force exerted by circulating blood on the walls of the arteries. It consists of two measurements: systolic and diastolic pressure.

Bradycardia - BR

slower than normal heart rate. In adults, it is defined as a heart rate of less than 60 beats per minute. (less than 100 bpm in infants)

Capillary Refill

quick and useful method to assess peripheral perfusion. (Measures how long it takes for blood to return to capillaries after they have been compressed.

Capnometry/Capnography

non-invasive method used to measure the carbon dioxide (CO2) in inhaled and exhaled air.

(Provides valuable insight into a pt alveolar ventilation, systemic metabolism, and circulatory status.

chief complaint - c/o

primary issue or symptom that prompts a patient to seek medical attention.

Clammy (skin)

often described as cool and moist. Associated with the body's response to stress or shock

(hypotension), where the body is not getting enough blood flow

close-ended question

type of question that can be answered with a simple, direct response, often limited to a single word or a short phrase.

conjunctiva

a thin, transparent mucous membrane that lines the inner surface of the eyelids and covers the exposed part of the sclera, which is the white of the eye.

constricted pupils (normal)

also known as miosis, occur when the pupils become smaller in size. This can be a normal response to bright light, to protect the eye from excessive light.

*Both should have the same response simultaneously (consensual reflex)

constricted pupils (medical)

Constricted pupils may suggest a central nervous system disorder or the use of narcotics.

cyanosis

a bluish discoloration of the skin and mucous membranes resulting from poor circulation or inadequate oxygenation of the blood.

(typically appears in areas like the lips, mouth, nose, fingernail beds, and conjunctiva*lines inner surface of eyelids* In dark-skinned individuals, it may be more noticeable in the oral mucosa or conjunctiva.)

Diastolic Blood Pressure - DBP

lower number in a blood pressure reading, indicating the pressure on the artery walls when the heart's ventricles are at rest between beats. (bottom #/ denominator)

-normal adult DBP 80mmHg or less.

-81-89mmHg considered pre-(hypertension) high blood pressure

-any adult DBP >90mmHg diastolic hypertension

If the artery is constricted (walls of artery tightened/ vasoconstriction) , the diastolic pressure increases.

Pupils Dilated

become dilated due to various factors, including drug use (e.g., LSD, amphetamines, cocaine), cardiac arrest, or severe brain injury.

In these cases, pupils may also be *fixed*, meaning they do not react to light.

Flushing

abnormally red skin color due to vasodilation. - (increase in blood flow and a decrease in blood pressure.)

-may be a sign of heat exposure, peripheral vasodilation *(widening of blood vessels, particularly those near the skin's surface.) *, or a very late finding in carbon monoxide poisoning

Glucometer

aka glucose meter, is a portable device used to measure the blood glucose level (BGL) in a patient.

Jaundice

condition characterized by yellowness of the skin, sclera of the eyes, mucous membranes, and body fluids.

- primarily due to an accumulation of bilirubin, a yellow pigment, in the blood. (may indicate liver disease)

Mottling

skin discoloration appearing as a blotchy pattern, similar to cyanosis. -often seen in patients experiencing shock (hypotension) or those with blood pooling in the extremities over a prolonged period

Open-ended question

designed to encourage detailed responses from patients, allowing them to express their thoughts and feelings in their own words

OPQRST

mnemonic used in medical history taking to assess a patient's chief complaint, particularly pain.

-Onset

(When and how did the symptom begin? Was it sudden or gradual?)

-Provocation/Palliation

(What makes the symptom worse or better?)

-Quality

(How would you describe the pain? Is it sharp, dull, throbbing, etc.?)

-Radiation

(Where do you feel the pain? Does it move to other areas?)

-Severity

(How bad is the symptom on a scale of 1 to 10?)

-Time

(How long have you had the symptom?)

Orthostatic Vital Signs (Tilt Test)

a series of vital signs measuring the pt's blood pressure and heart rate of a patient taken standing, sitting, and supine .

Supine- ( measuring the patient's BP and HR while they are lying down.)

Standing- pt. stand up and wait for 2min before reassessing their BP and HR

How long after swapping positions should an EMT allow for the patient to take another set of blood pressure vitals?

You should wait at least 2min before reassessing a patient's vitals whether it be the moment they stand up or in seating position moving from supine.

3 multiple choice options

After re positioning a patient from supine to standing, then reassessing the patient's vitals and given the appropriate time has passed. If the HR increases greater by ___-___BPM? Then the systolic blood pressure (SBP) decreases by ___-___mmHg?

10-20BPM / 10-20mmHg

3 multiple choice options

Pain Scale

a tool used to help patients describe and identify their pain.

Wong-Baker Faces Scale

scale uses a series of faces ranging from happy to crying to help patients, especially children over 3 years old, express their pain level.

-It can also be used for adults and those with communication difficulties.

FLACC Pain Scale

assess the pt's face, legs, activity, cry, and consolability. Designed to asses pain in children younger than 5 y/o.

- Although can be adapted for older children and adults

Pallor (paleness/white)

abnormal paleness of the skin, which can be an important indicator of the body's perfusion status.

-often assessing the color of the skin, nail beds, oral mucosa, and conjunctiva.

-Normally, these areas should appear pink

Pallor is a clear sign of these signs except:

red colorization in the skin or flushing

3 multiple choice options

Palpation

used in physical examinations where a healthcare provider uses their hands to feel the body, particularly to assess the presence of abnormalities.

-the SBP is measured by palpation

After inflating the cuff rapidly with the rubber bulb while palpating the radial pulse until you can longer feel. Without stopping how many mmHg should you continue to go above the level where the radial pulse can longer be felt/

30mmHg

3 multiple choice options

Pulse Oximeter

medical device used to measure the oxygen saturation level in the blood, specifically the percentage of hemoglobin saturated with oxygen, known as SpO2.

What are some limitations an pulse oximeter would have causing it to have an alteration or inaccurate readings?

-shock or hypoperfusion *(reduced or inadequate blood flow to tissue and organs)*

- hypothermia or cold injury to extremities

-excessive movement

-nail polish

-carbon monoxide will give high reading although cells are becoming severely hypoxic

- cigarette smokers may have flasely high SpO2

-Anemia

pulse oximetry

noninvasive method of measuring oxygen saturation level (Sp02) in the blood

the method not the device

Pulse Pressure (PP)

difference between systolic and diastolic pressure readings.

How is pulse pressure calculated?

What is the normal pulse pressure typically __% & ___% of SBP?

Between 25%-50%

- Less than 25% indicates a narrow pulse pressure (PP)

- more than 50 % indicates a widened PP *can be sign of head injury

pulsus paradoxus

drop in systolic blood pressure greater >10 mmHg with inspiration (inhalation)

-weaking or disappearance of the pulse when pt inhales

-can indicate severe cardiac or respiratory cond., severe asthma or significant blood loss.

SAMPLE History

- Signs and symptoms

- Allergies

- Medications

- Pertinent past medical history

- Last oral intake

- Events leading up to injury or illness

Signs

any objective physical evidence of medical or trauma conditions that you can see, hear, feel, or smell.

Sphygmomanometer

a device used to measure blood pressure. (Blood Pressure Cuff)

Stridor

strained, high-pitched sound heard on inspiration caused by obstruction in the pharynx or larynx

- a sign you can hear during pt assessment

Symptoms

Subjective characteristics/conditions that cannot be observed and must be described by the pt, such as pain in the abdomen or numbness in the legs.

Systolic Blood Pressure

the pressure created in the arteries when the left ventricle contracts (heart beats) and forces blood out into circulation (pump blood)

-If SBP is low, pulse will be weak or absent. Vice-versa

- Avg adult SBP 120 mmHg or less

-less than <90 mmHg indicates Hypotension (Low- Blood Pressure)

Tachycardia

Abnormally rapid heart rate. (fast-heart)

Tilt Test

aka (orthostatic vital signs test), method assessing a pt's blood volume status, particularly when volume loss is suspected.

-Pt starts in supine position first

Vital Signs

Measurements of the body's most basic functions and useful in detecting or monitoring medical problems.

-Respiration: Measures the *rate and quality*of breathing.

-Pulse: Assesses heart rate, strength, and regularity.

-Skin: Evaluates temperature, color, and condition.

-Pupils: Checks size, equality, and reactivity.

-Blood Pressure: Includes both systolic and diastolic measurements.

-Pulse Oximetry (SpO2): Determines oxygen saturation in the blood.