Baseline Vital Signs and SAMPLE History

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• Baseline Vital Signs and SAMPLE History

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Terminal Learning Objective

• Given a patient care scenario and the proper
  medical equipment in a clinical environment or
  field setting, assess a baseline set of patient
  vital signs and obtain an accurate SAMPLE history
  IAW Chapter 5, Emergency Care and Transportation
  of the Sick and Injured, 9th Edition, American
  Academy of Orthopedic Surgeons (AAOS).

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Enabling Learning Objectives

• Given a patient, with a trauma or
  medically-related complaint, in a pre-hospital
  environment, describe the basic principles,
  sequence and components of an accurate baseline
  set of vital signs IAW Emergency Care and
  Transportation of the Sick and Injured, 9th
  Edition, American Academy of Orthopedic Surgeons
  (AAOS).

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Enabling Learning Objectives

• Given a patient, with a trauma or
  medically-related complaint, in a pre-hospital
  environment, demonstrate the proper technique(s)
  for obtaining a complete set of baseline vital
  signs and a concise patient history using the
  acronym SAMPLE IAW Emergency Care and
  Transportation of the Sick and Injured, 9th
  Edition, American Academy of Orthopedic Surgeons
  (AAOS).

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Baseline Vital Signs and SAMPLE History

• Assessment is the most essential skill EMT-Bs
  learn.
• During assessment you
  will
• Gather key information
• Evaluate the patient
• Learn the history
• Learn about the patients overall health

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Gathering Key Patient Information

• Obtain the patients name.
• Note the age, gender and
• race.
• Look for identification if the
• patient is unconscious.

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Baseline Vital Signs

• During the assessment, the EMT-B uses many senses
  and a few basic medical instruments.
• First set is known as
  the baseline vitals.
• Repeated vital signs
  are compared to the
  baseline.

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Baseline Vital Signs and SAMPLE History

• Chief Complaint (CC) Mechanism of Injury (MOI)
• Chief complaints are the major signs, symptoms or
  events that caused the call or complaint
• Symptoms what the patient tells you
• Signs can be seen, heard , felt, smelled or
  measured

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Obtaining a SAMPLE History

• S Signs and Symptoms of the episode
• What signs and symptoms occurred at onset?
• Does the patient report pain?

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Obtaining a SAMPLE History

• A Allergies
• Is the patient allergic to medications, foods or
  other substance?
• What reactions did the patient have to any of
  them?
• Note If the patient has no know allergies,
  you should note this on the run sheet as no
  known allergies or NKA

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Obtaining a SAMPLE History

• M Medications
• What medications was the patient prescribed?
• What dosage was prescribed?
• How often is the patient supposed to take the
  medication?
• What prescription, over-the-counter (OTC)
  medications, and herbal medications has the
  patient taken in the last 12 hours?
• How much was taken and when?

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Obtaining a SAMPLE History

• P Pertinent past history
• Does the patient have any history of medical,
  surgical, or trauma occurrences?
• Has the patient had a recent illness or injury,
  fall or blow to the head?

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Obtaining a SAMPLE History

• L Last oral intake
• When did the patient last eat or drink?
• What did the patient eat or drink, and how much
  was consumed?
• Did the patient take any drugs or drink alcohol?
• Has there been any other oral intake in the last
  4 hours?

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Obtaining a SAMPLE History

• E Events leading to injury or illness
• What are the key events that led up to this
  incident?
• What occurred between the onset of the incident
  and your arrival?
• What was the patient doing when this illness
  started?
• What was the patient doing when this injury
  happened?

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O-P-Q-R-S-T

• Mnemonic device to help you remember questions
  you should ask to obtain a patient history.
• O Onset When did the problem begin and what
  caused it?
• P Provocation or Palliation Does anything make
  it feel better? Worse?

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O-P-Q-R-S-T

• Q Quality What is the pain like? Sharp, dull,
  crushing, tearing?
• R Region/Radiation Where does it hurt? Does
  the pain move anywhere?
• S Severity On a scale of 1 to 10, how would
  you rate your pain?
• T Timing of pain Has the pain been constant or
  does it come and go? How long have you had the
  pain?

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Baseline Vital Signs

• Baseline vital signs always include
• Respirations, Pulse Blood Pressure
• Other key indicators
• Skin color, condition, temperature (CCT)
• Capillary refill time (in children)
• Pupillary response
• Level of Consciousness (LOC)
• Sometimes Temperature (medical patients)

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Respirations

• A patient who is breathing without assistance
  spontaneous respirations.
• Each complete breath consists of two distinct
  phases
• Inspiration (inhalation) the chest rises up and
  out, drawing oxygenated air into the lungs
• Expiration (exhalation) the chest returns to its
  original position, releasing air with an
  increased carbon dioxide (CO²) level out of the
  lungs

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Respirations

• Rate
• The number of breaths in 30 seconds x 2
• Quality character of breathing
• Rhythm (regular or irregular)
• Effort (normal or labored)
• Depth
• - Tidal Volume (the amount of air exchanged
  with each breath)
• -Depth and rate of breathing determines
  the tidal volume

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Respiratory Rate

• Adults 12 to 20 breaths/minute
• (over age 8)
• Children 18 to 30 breaths/minute
• (1 to 8 years of age)
• Infants 30 to 60 breaths/minute
• (under 1 year of age)

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Respirations

• Effort (labored)
• Unable to speak more than 2-3 words at a time
• Assuming a tripod position
• Assuming a sniffing position (children)
• Noisy breathing
• Stridor
• Wheezes, snoring
• Coughing (productive?)

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Pulse Oximetry

• Evaluates the effectiveness of oxygenation.
• Normal value 95 - 100.

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Pulse

• With each heartbeat, ventricle contract,
  forcefully ejecting blood from the heart and
  propelling it into the arteries.
• A pulse is the pressure
  wave that occurs as
  each heartbeat causes
  a surge in the blood
  circulating through the
  arteries.

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Pulse
Carotid Pulse
Radial Pulse
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Pulse
Brachial Pulse
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Pulse

• Rate
• Number of beats in 30 seconds x 2
• Strength
• Stronger than normal (bounding), strong or weak
  (thready)
• Regularity
• Regular or irregular

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Normal Pulse Ranges

• Adults 60 to 100 beats/minute
• Children 70 to 120 beats/minute
• Toddlers 90 to 150 beats/minute
• Newborns 120 to 160 beats/minute

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The Skin

• The condition of the patients skin can tell you
  a lot about the patients
• Peripheral circulation and perfusion
• Blood oxygen levels
• Body temeperature

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The Skin (CCT)

• Color
• Pink, pale, blue, red, or yellow
• Condition (moisture)
• Dry, moist or wet
• Temperature
• Warm, hot or cool

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Capillary Refill

• Evaluates the ability of the circulatory system
  to restore blood to the capillary system
  (perfusion).
• Evaluated at the nail bed (finger)
• Depress the finger tip, pressure forcing blood
  from the capillaries and look for return of blood

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Capillary Refill

• As the capillaries refill, should return to its
  normal deep pink color
• Color should be restored within 2 seconds (about
  the time it takes to say, Capillary refill
• Invalid test in a cold environment elderly
• Used for lt 6 years old

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Blood Pressure

• Blood pressure is a vital sign.
• Pressure of circulating blood against the walls
  of the arteries.
• A drop in blood pressure may indicate
• Loss of blood
• Loss of vascular tone
• Cardiac pumping problem
• Blood pressure should be measured in all patients
  older than 3 years of age.

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Blood Pressure

• Diastolic
• Pressure during relaxing
  phase of the hearts cycle
• Systolic
• Pressure during contraction
• Measured as millimeters
  of mercury (mmHg).
• Recorded as systolic/diastolic.

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Blood Pressure Equipment
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Auscultation of Blood Pressure

• Place cuff on patient's arm (1 above elbow).
• Palpate brachial artery and place diaphragm of
  stethoscope over artery.
• Inflate cuff until you no
  longer hear pulse sounds.
• Continue pumping to
  increase pressure by
  an additional 20 mmHg.

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Auscultation of Blood Pressure

• Note the systolic and
  diastolic pressures
  as you let air escape
  slowly.
• As soon as pulse
  sounds stop, open the
  valve and release the
  air quickly.

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Measuring Blood Pressure
Palpation
Auscultation
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Palpation of Blood Pressure

• Secure cuff.
• Locate radial pulse.
• After the pulse disappears continue to inflate
  another 30mmHg.
• Release air until pulse is felt.
• Method only obtains systolic pressure.

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Normal BP Ranges
Age Range Adults 90 to 140 mmHg
(s) 60 to 90 mmHg (d) Children (1-8) 80
to 110 mmHg (s) Infants (up to 1 yr) 50 to 90
mmHg (s) Varies with age and gender.
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Blood Pressure

• Hypotension
• BP significantly lower than the normal range
• Critical hypotension BP is no longer able to
  compensate sufficiently to maintain adequate
  perfusion
• Hypertension
• BP significantly higher than the normal range

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Level of Consciousness

• A - Alert
• V - Responsive to
• Verbal stimulus
• P - Responsive to Pain
• U - Unresponsive

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Pupil Assessment

• P - Pupils
• E - Equal
• A - And
• R - Round
• R - Regular in size
• L - React to Light

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Abnormal Pupil Reactions

• Fixed with no reaction
  to light.
• Dilate with light and
  constrict without light.
• React sluggishly.
• Unequal in size.
• Unequal with light or
  when light is removed.

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Reassessment of Vital Signs

• The vital signs you obtain serve two important
  functions
• First set establishes a baseline of respiratory
  and cardiovascular system status
• Serves as a key baseline

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Reassessment of Vital Signs

• Reassess stable patients every 15 minutes.
• Reassess unstable
  patients every
  5 minutes.
• Reassess/record
  VS after all medical
  interventions.

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• Questions?