Emergency Care 14th Edition - Chapter 13

Auscultation

Listening.... A stethoscope is used to auscultate for characteristic sounds

Blood Pressure

the force of blood against the walls of the blood vessels

Blood Pressure Monitor

a machine that automatically inflates a blood pressure cuff and measures blood pressure

Brachial Artery

the major artery of the arm

Brachial Pulse

the pulse felt in the upper arm

Bradycardia

a slow pulse; any pulse below 60 beats per minute

Carotid Pulse

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

Constrict

get smaller

diastolic blood pressure

the pressure remaining in the arteries when the left ventricle of the heart is relaxed and refilling

dilate

get larger

Oxygen Saturation (SpO2)

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

Palpation

touching or feeling. A pulse or blood pressure may be palpated with the fingertips

pulse

the rhythmic beats felt as the heart pumps blood through the arteries

pulse oximeter

an electronic device for determining the amount of oxygen carried in the blood, known as the oxygen saturation or SpO2

pulse quality

the rhythm (regular or irregular) and force (strong or weak) of the pulse

pulse rate

the number of pulse beats per minute

pupil

the black center of the eye

radial pulse

the pulse felt at the wrist

reactivity

in the pupils of the eyes, reacting to light by changing size

respiration

the act of breathing in and breathing out

respiratory quality

the normal or abnormal (shallow, labored, or noisy) character of breathing

respiratory rate

the number of breaths taken in one minute

respiratory rhythm

the regular or irregular spacing of breaths

sphygmomanometer

the cuff and gauge used to measure blood pressure

systolic blood pressure

the pressure created when the heart contracts and forces blood out into the arteries

tachycardia

a rapid pulse; any pulse rate above 100 beats per minute for an adult

vital signs

outward signs of what is going on inside the body, including respiration, pulse, skin color, temperature, and condition (plus capillary refill in infants and children), pupils and blood pressure

Capnography

graphical measurement of how much CO2 a patient is exhaling

Capnometry

numeric only measurement of how much CO2 a patient is exhaling

Normal Blood Glucose Level

70-100 mg/dL blood glucose level is normal

Normal O2 saturation %

96-100% O2 saturation

Mild Hypoxia O2 saturation

91-95% O2 saturation

Significant or Moderate Hypoxia O2 saturation

86-90% O2 saturation

Severe Hypoxia O2 saturation

85% or less O2 saturation

Cautions to Pulse Ox Reading

- Pulse Ox is inaccurate with patients in shock or hypothermia - due to shunting, - Pulse Ox will provide false high readings in carbon monoxide exposure. Chronic smokers have 10%-15% hemoglobin bound with CO., - Excessive patient movement will cause inaccurate readings, - Nail polish will interfere in Pulse Ox readings, - Anemia and hypovolemia patients potentially have falsely high SpO2 readings, - Low battery level or cleaning can affect pulse ox readings,

Temperature Measurement Locations on Patient

Oral or axillary temp in armpit, -Rectal - not practical in field of EMS, -Tympanic - measures temperature in ear - per book not accurate enough for EMS use, - Forehead thermometers/strips are not accurate enough,

Normal Blood Pressure

120/80 is normal adult BP

Hypertension

systolic of 140 mmHg or diastolic of 90 mmHg or more

Serious Low BP

When systolic is less than 90 mmHg

Causes for Un-reactive Pupils

Drugs or Lack of O2 to brain

Causes for Un-Equal Pupils

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

Causes for Constricted Pupils

Drugs (narcotics), prescription eye drops

Causes for Dilated Pupils

Fright, blood loss, drugs, prescription eye drops

Causes for Hypertension

Medical Condition, exertion, fright, emotional distress, or excitement

Causes for Hypotension

Athlete, normally low BP person, blood loss, late sign of shock

Cause for No Blood Pressure - but PT. is conscious

Patient with Ventricular assist device in the chest (constant flow pump)

Skin Temp/Condition - cool, clammy

Sign of shock, or anxiety (skin condition)

Skin Temp/Condition - cold moist

body is loosing heat (skin condition)

Skin Temp/Condition - cold, dry

exposure to cold (skin condition)

Skin Temp/Condition - hot, dry

Exposure to heat, high fever

Skin Temp/Condition - hot, moist

Exposure to heat, high fever

Skin Temp/Condition - Goose Pimples with shivering, chattering teeth, blue lips, and pale skin

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

Skin Color - Pink

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

Skin Color - Pale

constricted blood vessels - sign of shock, blood loss, hypotension, or emotional distress

Skin Color - Cyanotic (blue-gray)

Lack of O2 (hypoxic) in tissues - either respiratory or circulatory system issue

Skin Color - Flushed (red)

Exposure to Heat, emotional excitement

Skin Color - Jaundiced (yellow)

Liver issue

Skin Color - Mottled (blotchy)

Occasionally in patient with shock

Check Skin Color - Infants & Children

palm of hands or soles of feet (skin color check)

Respiratory Quality - Stridor

INHALATION - high pitch harsh sound - Upper Airway

Respiratory Quality - Snoring

need to open airway (typically tongue) (Upper Airway) - prompt transport

Respiratory Quality - Wheezing

Constriction (Lower Airway) - Medical Problem - Asthma ? - assist pt with prescribed medication - prompt transport

Respiratory Quality - Gurgling

Suction Airway needed - Upper Airway

Respiratory Quality - Crowing

Noisy harsh sound during Inhalation - can not be dealt with in field - transport promptly

Respiratory Rate - Normal

12-20 normal - ADULT

Respiratory Rate - Serious High

Above 24 respirations per minute - ADULT

Respiratory Rate - Serious Low

Below 10 respirations per minute - ADULT

6 Vital Signs

Pulse, BP, Respiration Rate, Pupils, Skin - color/temp/condition, Pulse Ox

Pulse Rate - Normal Adult/Adolescent

60-100 beats per minute (adult)

Pulse Rate - Normal School Age

65-120 beats per minute

Pulse Rate - Normal Preschooler

70-120 beats per minute

Pulse Rate - Normal Toddler

80-140 beats per minute

Pulse Rate - Normal Infant

90-160 beats per minute

Pulse Rate - Normal Newborn

100-170 beats per minute

Pulse Quality - Rapid, regular, full

Exertion, fright, fever, high blood pressure, first stage of blood loss

Pulse Quality - Rapid, regular, thready

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

Pulse Quality - Irregular

Abnormal electrical activity in the heart

Pulse Quality - Slow

Head Injury, drugs, some poisons, some heart problems, lack of O2 in Children

Pulse Quality - No Pulse

Cardiac arrest - or ventricular assist device if patient is awake

Pulse Quality - No Pulse - but PT. is conscious

ventricular assist device if patient is awake