Baseline Vital Signs, Monitoring Devices, and History Taking

Chapter 11
Baseline Vital Signs, Monitoring

Devices, and History Taking
Prehospital Emergency Care, Ninth Edition

Joseph J. Mistovich Keith J. Karren
Copyright 2010 by Pearson Education, Inc.

All rights reserved.
Objectives
1.
2.
3.
Define key terms introduced in this chapter.

Explain the importance of taking and recording a
patients vital signs over a period of time to identify
problems and changes in the patients condition and of
accurately documenting the vital signs and patient
history (slides 18, 48).
Perform the steps required to assess the patients
breathing, pulse, skin, pupils, blood pressure, and
oxygen saturation and consider the patients overall
presentation when interpreting the meaning of vital sign
findings (slides 19-55).
Objectives
4.
5.
6.
Differentiate between normal and abnormal findings when

assessing a patients breathing, to include the respiratory
rate, quality of respirations, rhythm of respirations, and signs
that may indicate respiratory distress or respiratory failure (
slides 19-24).
Differentiate between normal respiratory rates for adults,
children, infants, and newborns and evaluate the need to
administer treatment based on assessment of a patients
breathing (slide 20).
Auscultate breath sounds to determine the presence of
breath sounds, equality of breath sounds, and the presence
and likely underlying causes of abnormal breath sounds (
slides 21-22).
Objectives
7.
8.
9.
Assess the pulse at various pulse points and consider

the patients age and level of responsiveness when
selecting a site to palpate the pulse (slides 25-26).
Differentiate between normal and abnormal findings
when assessing a patients pulse, to include the pulse
rate, quality of the pulse, and rhythm of the pulse (
slides 27-30).
Associate pulse abnormalities with possible underlying
causes and describe the changes in the pulse
associated with pulsus paradoxus (slide 27, 29).
Objectives
10. Recognize normal and abnormal findings in the
assessment of skin color, temperature, condition,
capillary refill, and color of the mucous membranes and
associate abnormal skin findings with potential
underlying causes (slides 31-36).
11. Explain factors that can affect capillary refill findings (
slides 35-36).
12. When assessing the pupils, recognize dilation,
constriction, inequality, and abnormal reacitivty and
associate abnormal findings with potential underlying
causes (slides 37-38).
Objectives
13. In relation to blood pressure measurement, explain systolic
and diastolic blood pressure, consider normal values for age
and gender, find the pulse pressure, and identify potential
causes of abnormal findings or changes (slides 39-41).
14. Compare palpation and auscultation of blood pressure as to
processes, useful findings, and documentation and discuss
how technique and selection of equipment can affect the
accuracy of readings (slides 42-43).
15. Demonstrate assessment of orthostatic vital signs (
slides 44-45).
16. Given a patient scenario, determine the frequency with
which vital signs should be reassessed (slides 46-47).
Objectives
17. Explain what pulse oximetry measures, use pulse
oximetry to help determine the need for supplemental
oxygen, and describe factors and limitations in
interpreting pulse oximetry findings (slides 50-55).
18. Describe the correct procedure for noninvasive blood
pressure monitoring (slides 56-57).
19. Describe the processes for controlling the scene,
achieving a smooth transition of care, and reducing the
patients anxiety (slides 59-66).
20. Determine a patients chief complaint (slides 67-68).
Objectives
21. Given a scenario, efficiently elicit an adequate patient
history using closed-ended and openended questions
and active listening techniques (slides 69-78).
22. Use the mnemonics SAMPLE and OPQRST to ensure
a complete prehospital patient history (slides 79-82).
23. React appropriately when asking questions about
sensitive topics or when caring for patients who
present special challenges to history-taking and
assessment (slides 83-84).
Multimedia Directory
Slide 48Vital Sign Assessment Video
Topics
Gathering Patient Information
Baseline Vital Signs
Monitoring Equipment
Preparing to Take the History
Taking the History
CASE STUDY
Dispatch
EMS Unit 114
Respond to 1895 East State Street for an

unknown medical emergency called in by family
member.
Time out 1748
Upon Arrival
Daughter states she hadnt been able to reach

her father, Mr. Li, all day
She broke in and found him lying on the floor
She states that he seems weak and in pain
How would you proceed to assess and

care for this patient?
Gathering Patient
Information
Back to Topics
What is wrong with the patient?
Baseline Vital Signs
Back to Topics
Respirations
Pulse
Skin
Pupils
Blood Pressure
Back to Objectives
Breathing (Respiration)
Breathing
(Respiratory) Rate
Back to Objectives
Observe rise
and fall of chest
Ranges for all
age groups
Back to Objectives
Breathing
(Respiratory) Quality
Back to Objectives
Normal
Shallow
Labored
Noisy
Breathing
(Respiratory) Rhythm
Regular
Irregular
Pulse
Location of Pulses
Back to Objectives
Carotid
Femoral
Radial
Brachial
Popliteal
Posterior
tibial
Dorsalis pedis
Pulse
Pulse Rate
Back to Objectives
Average rate
Tachycardia
Bradycardia
Pulse
Pulse Quality and

Rhythm
Back to Objectives
Strong
Weak
Regular
Irregular
Skin
Skin Color
Back to Objectives
Pallor
Cyanosis
Flushing
Jaundice
Mottling
Skin
Skin Temperature and

Condition
Hot
Cool
Cold
Dry
Clammy
Diaphoresis
Skin
Capillary Refill
Back to Objectives
( Daniel Limmer)
Compressed capillaries
to refill with blood
More reliable in infants
and children than adults
Pupils
Back to Objectives
Size
Equality
Reactivity
Blood Pressure
Back to Objectives
Systolic
Korotkoffs sound
Diastolic
Normal Range
Adult male
Adult female
Child age one to
ten years
Child greater than
age ten years
Blood Pressure
Methods of Measuring
Blood Pressure
Back to Objectives
Auscultation
Palpation
Testing Orthostatic Vital

Signs
Back to Objectives
Supine
Standing
Tilt test
Vital Sign Reassessment
Back to Objectives
Stable every 15 minutes

Unstable every five minutes
Vital Sign Assessment
Click here to view a video on the topic of vital sign assessment.

Return to Directory
Monitoring Equipment
Back to Topics
Pulse Oximeter: Assessing

Oxygen Saturation
Back to Objectives
Pulse oximetry
Purpose
Function
Signs of hypoxia
Pulse Oximeter: Assessing Oxygen

Saturation
Indications for Pulse

Oximetry and Limitations to
the Pulse Oximeter
Indications
Limitations
Pulse Oximeter: Assessing Oxygen

Saturation
Procedure for Determining

the SpO2 Reading
Turn on
Attach to patient
Troubleshoot any errors
Continually reassess
Noninvasive Blood Pressure

Monitor
Back to Objectives
Automatically measures
blood pressure
Procedure for monitoring
Preparing to Take the

History
Back to Topics
Gain Control of the Scene
Back to Objectives
Competence
Confidence
Compassion
Achieve a Smooth
Transition of Care
Introduce yourself and your partner

Gain information from First Responders
Reduce the Patients

Anxiety
Bring order
Introduce yourself
Gain consent
Position yourself
Use communication
skills
Be courteous
Use touch when
appropriate
Maintain Control
Attempt to control the scene

If it cannot be controlled, rapidly
remove yourself and the patient
Taking the History
Back to Topics
Chief complaint
Gather history
from patient or
family
Back to Objectives
Statistical and Demographic

Information
Back to Objectives
Date
Time
Identifying data
Current Health Status
Medications
Allergies
Tobacco
Drugs, alcohol
Use of safety
equipment
Family history
Techniques for Taking a Patient

History
Note Taking
Take notes to present information

as accurately as possible.

History
Note Taking
Types of Questions
Open-ended question
Closed-ended question

History
Active Listening
Techniques
Facilitation
Reflection
Clarification
Empathetic
response
Confrontation
Interpretation
Standardized Approach to History

Taking
The SAMPLE History
Back to Objectives
Signs and symptoms

Allergies
Medications
Pertinent past history
Last oral intake
Events leading to the injury
Standardized Approach to History

Taking
Assessing Patient
Complaints: OPQRST
Onset
Provocation
Quality
Radiation
Severity
Time
Sensitive Topics or Special

Challenges
Back to Objectives
Sensitive Topics
Challenges
CASE STUDY
Follow-Up
CASE STUDY
Patient Assessment
No problems with ABCs
Apply cervical collar
Vitals: BP: 168/82 mmHg; pulse: 78
regular; RR: 18; skin pink, warm and
dry
Patient complains of left hip pain
CASE STUDY
Patient Assessment
Allergies to PCN
Hip joints replaced in 1989
Fell about 11 a.m. this morning
Transport to hospital unremarkable
Critical Thinking Scenario

56-year-old male fell from the roof of his
house onto the concrete driveway
Patient is not alert, appears to have fallen
head first, and has severe head trauma
Large amount of blood from his mouth, nose,
and ears
Gurgling sounds with each respiration
His wife arrives home while youre on scene
and begins to scream frantically
Critical Thinking Scenario

Vital signs:
BP: 198/72 mmHg
HR: 48 bpm; radial pulse is slow but
strong
RR: 45 per minute; rapid with minimal
chest movement
SpO2 is 76 percent
Skin is cyanotic, warm, and dry
Critical Thinking Questions

1. What is the significance of the gurgling
sound?
2. How would you document the pulse
rate?
3. What does the pulse oximeter reading
indicate?
4. What do the skin signs indicate?
Critical Thinking Questions

5. What other vital signs would be
important to assess in this patient?
6. When would you attempt to gather a
SAMPLE history?
7. How would you gather the SAMPLE
history?
8. What information would you be able to
gather using the OPQRST mnemonic?
Reinforce and Review
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What are vital signs used for?

What are vital signs used for?

What are the steps to assess breathing?

What are the steps to assess breathing?

Chapter 11

Baseline Vital Signs, Monitoring

Prehospital Emergency Care, Ninth Edition

Copyright 2010 by Pearson Education, Inc.

Define key terms introduced in this chapter.

Differentiate between normal and abnormal findings when

Assess the pulse at various pulse points and consider

EMS Unit 114

Respond to 1895 East State Street for an

Time out 1748

Daughter states she hadnt been able to reach

How would you proceed to assess and

What is wrong with the patient?

Baseline Vital Signs

Pulse Quality and

Skin Temperature and

Testing Orthostatic Vital

Vital Sign Reassessment

Stable every 15 minutes

Vital Sign Assessment

Click here to view a video on the topic of vital sign assessment.

Pulse Oximeter: Assessing

Pulse Oximeter: Assessing Oxygen

Indications for Pulse

Pulse Oximeter: Assessing Oxygen

Procedure for Determining

Noninvasive Blood Pressure

Preparing to Take the

Gain Control of the Scene

Introduce yourself and your partner

Reduce the Patients

Attempt to control the scene

Taking the History

Statistical and Demographic

Current Health Status

Techniques for Taking a Patient

Take notes to present information

Techniques for Taking a Patient

Techniques for Taking a Patient

Standardized Approach to History

The SAMPLE History

Signs and symptoms

Standardized Approach to History

Sensitive Topics or Special

Critical Thinking Scenario

Critical Thinking Scenario

Critical Thinking Questions

Critical Thinking Questions

Reinforce and Review

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