vital signs and responding to emergencies and wound care

5 korotkoff sounds

• 1

  • Sharp tapping

  • Represents systolic reading

• 2

  • Softer tapping

• 3

  • Tapping gets louder

• 4

  • Muffled tapping

• 5

  • Sound disappears

  • Diastolic reading

steps for taking blood pressure

1. position patient

   1. sitting and feet flat on floor

   2. arm resting at heart level on table

   3. palm up

2. choose and examine arm

   1. roll up long sleeves, no tight clothing

   2. no arm with dialysis shunt, injury, mastectomy, etc

3. choose right cuff size

   1. width: ⅔ of length from shoulder to elbow

   2. length: should circle 80-100% of arm, should wrap to be within indicator line range

4. palpate brachial artery with first 3 fingers

   1. toward medial antecubital space

5. center tubed part and wrap cuff snuggly

   1. to sit over brachial artery, end cuff1 inch above elbow bend

   2. make sure needle of monitor is at 0

6. position stethoscope

   1. put in ears and hold diaphragm on brachial artery near elbow bend with left hand

7. pressurize bulb by puffing

   1. screw valve near it closed with right hand

   2. puff until needle on cuff goes 30 mmHg over last previous systolic BP

8. release pressure

   1. carefully screw open with index and thumb

   2. release air at 2-3 mmHg per second

9. listen for sounds

   1. Note number when you hear the first clear korotkoff sound

   2. Note where you heard last sound

   3. Continue to steadily release air 10 mmHg past when sounds disappear

10. Fully open valve and remove cuff

11. Repeat on same side or other arm after 1 minute

    • If patients first visit

    • If patients reading is elevated

what to do if they have orthostatic hypotension

• 3 readings immediately after the other without removing cuff

• First one

  • Lying supine for 5 min then check BP and pulse

• Second

  • Sitting, check BP and pulse

• Third 

  • Standing, check BP and pulse

  • Check after standing for 1, then 3 minutes

  • Keep arm on table so that its not hanging

• Inform patient of results

  • If pulse is increased by 10 BMP and pressure decreased by 20 between positions, they have it

temperature differences by route

oral

• affected by drinking and smoking

R = most accurate, 1 higher than oral (for under 3 yrs)

• put up to ½ in inside infants

AX = 1 lower than oral (least accurate, use as last resort)

tympanic and temporal dont say

steps for palpated BP (only in emergencies)

1. place cuff in regular position

2. palpate radial pulse

   1. thumb side of wrist

3. inflate cuff until you feel pulse disappear

4. inflate 30 mmHg more

5. dont move or change pressure of fingers from pulse

6. note reading when first pulse is felt

7. mark as XmmHg/P (indicates it was palpated)

ways to characterize respirations

• Rate (bpm)

• rhythm (regular vs irregular)

• depth (amount of air)

ways to characterize pulse

volume (weak vs bounding)

rate

rhythm

hypoglycemia - symptoms and treatment

symptoms: irritability, moodiness, hunger, sweating, and rapid heart rate.​​​​​​​

fainting, seizures, confusion, headache, coma

treatment: consume 15g of foods or liquid high in glucose for mild. give glucagon for severe

Hypovolemic shock

due to loss of excessive blood and fluids

symptoms: Thirst, muscle cramping, and lightheadedness, chest pain, confusion, lethargy

treatment: Control of blood loss, blood transfusion, and IV fluid replacement

heat stroke

symptoms: Muscle cramping, perspiration, and pale and clammy skin.

treatment: Apply any available cold compresses, remove from heat

hypothermia or frostbite

symptoms: shivering, numbness, confusion, paleness, and eventual loss of consciousness

frostbite: redness and tingling then pale and numb

treatment: Remove any wet clothing. Cover the individual with a blanket. Provide any available warm/dry compresses and any warm beverages.

choking

symptoms:  hand at their throat, not able to cough or speak

treatment: Abdominal thrusts for older than 1,  chest thrusts then back slaps for younger

syncope

symptoms: Pale, perspiring, and complain of nausea or dizziness

treatment: lie supine, feet above heart

immediate fracture treatment

stop bleeding by elevating the body part and applying pressure.

Immobilize the injured area and apply localized cold to the area, such as an ice pack in cloth

shock

response to adrenaline that causes capillary contriction —> less blood to tissues, low BP, can result from many things

symptoms: pale, cold, clammy skin, a rapid or weak pulse, and fast, shallow breathing

treatment: control bleeding, keep warm with blanket, elevate feet abt 12 inches

anaphylactic shock

symptoms: pale and clammy skin, weakness, restlessness, rapid pulse and respiratory rate, vomiting —> apathy, unresponsiveness, dilated pupils, mottled skin, and loss of consciousness

treatment: call 911, give EpiPen, lay the patient down and elevate the legs and feet slightly, give CPR if not breathing

seizure

symptoms: Uncontrolled muscle activity

treatment: Help them to the floor, move objects out of way, turn on side

poisoning

symptoms: discoloration or burns on the lips, unusual odor, emesis (vomiting), or presence of a suspicious container, drowsy, difficult breathing, seizures

treatment: call 911 if last 3, remove any poison seen (on lips, on skin, etc)

open wound PPE

sterile gloves when doing sterile dressing, surgical mask, any gloved when changing dressing

3 types of bleeding from wounds (dictates what kind of first aid to give)

arterial

• high pressure —> spurts,

• most severe,

• bright red

venous

• steady flow of dark blood

capillary

• minimal bleeding

first aid for arterial and venous bleeding

• put pressure on site with sterile gauze

• elevate site

• ask provider if its needed to put tourniquet above site

• venous doesn’t need tourniquet

dressing wound steps

• check what provider says to clean with

• PPE —> non sterile gloves, mask

• set up sterile mayo stand with dressings etc

• clean with swab down middle top to bottom, other swabs on each side

• wash hands

• remove sterile dressing from package and drop into sterile field

• put on sterile gloves

• press dressing over wound, dont move it

• wrap bandage over dressing

• use tape to secure bandage

changing dressing steps

• set up side table and non sterile gloved

• cut bandage to side of wound with bandage scissors

• remove bandage without removing dressing

• corners of dressing toward center of wound

  • If you encounter resistance stop and pour saline over to loosen it

• Dispose dressing and gloves in biohazard container

  • Inspect inner portion for draining or odor before

• set up sterile field and do dressing steps

1st degree burn

outer layer of skin tissue red and swelling

treatment: holding the area under cool running water for about 10 min, piece of ice in the mouth,  apply a lotion, such as one with aloe vera or cocoa butter

2nd degree burn

symptoms: breaks the surface of the skin and injures the underlying tissue, blisters appear, red or mottled, wet when plasma is lost through skin

from: severe sunburn, exposure to hot liquids or heat

treatment: cool water, don’t pop blisters, if blisters pop —> clean the area with water and apply an antibiotic ointment, wrap skin loosely with dressing bandaging,

3rd degree burn

deep enough to damage the nerves and bones

symptoms: charred and white tissue,  less pain because the nerves are damaged

from: exposure to fire, hot water, hot objects, or electricity

treatment: Call 911, Do not try to remove clothing stuck, Remove jewelry, belts, and other tight  things, Cover the burn. Loosely cover the area with gauze or a clean cloth, raise area above heart, watch for signs of shock and not breathing

4th degree

can get to deeper tissue like muscle and bone

no feeling bc nerves are destroyed

 caused by flames and chemicals

treatment

Call 911, Do not try to remove clothing stuck, Remove jewelry, belts, and other tight  things, Cover the burn. Loosely cover the area with gauze or a clean cloth, raise area above heart, watch for signs of shock and not breathing

CPR steps

1. 30 chest compressions

2. tilt head back

3. pinch nose

4. 2 slow breaths

5. Repeat

myocardial infarction

when heart muscle stops recieving blood due to blockage in coronary artery

symptoms:

• Chest pain or discomfort in the center or left side of the chest

• Pain or discomfort in one or both arms, the back, shoulders, neck, or jaw or above the belly button

• Shortness of breath when resting or doing a little bit of physical activity 

• Excessive sweating for no reason

• Feeling unusually tired for no reason, sometimes for days

• Nausea and vomiting

• Light-headedness or sudden dizziness

• Rapid or irregular heartbeat

treatment:

• aspirin, nitroglycerin, or thrombolytics to dissolve blood clots blocking coronary artery

• administer oxygen

cardiac arrest

when the heart stops pumping blood

collapse suddenly and lose consciousness, stop breathing or gasp for air, not respond to shouting or shaking, and not have a pulse

cheack for pulse for only 10 sec

if not, do AED. should be within 3 minutes of location. if no AED, do CPR