ch12 lecture

(1)

Emergency Medical Responder

First on Scene

CHAPTER

TENTH EDITION

Obtaining a Medical

History and Vital Signs

(2)

Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron

Objectives

1. Define the following terms:

a.

Auscultation

b.

Baseline vital signs

c.

Blood pressure

d.

Capillary refill

e.

Chief complaint

f.

Cyanotic

g.

Diaphoretic

h.

Diastolic

(3)

Objectives

1. Define the following terms:

i.

Medical history

j.

Mental status

k.

OPQRST

l.

Palpation

m.

Pulse

n.

Respiration

o.

SAMPLE history tool

p.

Sign

(4)

Objectives

1. Define the following terms:

q.

Stethoscope

r.

Symptom

s.

Systolic

t.

u.

Vital signs

v.

Work of breathing

(5)

Objectives

2. Explain the importance of a thorough

medical history.

3. Differentiate between a sign and a

symptom.

4. Describe the components of the

SAMPLE history tool.

5. Describe the components of the

OPQRST assessment tool.

(6)

Objectives

6. Explain the role that monitoring vital

signs plays in the overall assessment

and care of the patient.

7. State the characteristics that are

obtained and measured when

assessing respirations, pulse, blood

pressure, skin signs, and pupils.

8. Describe the methods used to assess

each of the five vital signs.

(7)

Objectives

9. Differentiate the techniques used to

assess a pulse in an infant, child, and

adult patient.

10. Differentiate normal and abnormal

vital sign values for the infant, child,

and adult patient.

(8)

Objectives

11. Demonstrate the ability to properly

obtain and accurately trend and

document vital signs.

12. Demonstrate a caring and

compassionate attitude with

(9)

Media Directory

(10)

Topics

(11)

(12)

Obtaining a Medical History

• Medical history

(13)

Obtaining a Medical History

• Signs



Something you can see and observe

about patient

• Pale skin

• Rapid pulse

• Open wound to chest

(14)

(15)

Obtaining a Medical History

• Symptom



Something patient feels or may

complain about

• Can be obvious or very subtle

(16)

(17)

Obtaining a Medical History

• Interviewing Your Patient



An alert patient is the best source of

information.



Chief complaint

• Ask questions slowly and clearly.

• Allow time for patient to process and

respond.

• Listen carefully.

• Document important details.

(18)

Obtaining a Medical History

• Interviewing Your Patient



Establish a good rapport.

• Introduction

• Consent

• Patient's name

• Patient's age

• Chief complaint

(19)

Obtaining a Medical History

• Interviewing Your Patient



SAMPLE history tool

• S

igns/symptoms

• A

llergies

• M

edications

• P

ast pertinent medical history

• L

ast oral intake

• E

vents leading to the illness or injury

(20)

Obtaining a Medical History

• Interviewing Your Patient



OPQRST is the most commonly used for

assessment of pain or discomfort.

• O

nset

• P

rovocation

• Q

uality

• R

egion/

R

adiate

• S

everity

(21)

Obtaining a Medical History

• Additional Sources of Information



Family members



Bystanders



First responders

(22)

(23)

Think About It

• You become suddenly ill and a medical

provider begins asking you personal

medical history questions. What would

make you more likely to be honest and

forthright with answers?

• How could you apply this answer to

your own assessment practices?

(24)

Think About It

• How would you handle questions such

as:



_{Have you been drinking?}



Have you taken any drugs that are not

prescribed for you?

(25)

(26)

Vital Signs

• Respiration

• Pulse

• Blood pressure

• Skin signs

• Pupils

(27)

Vital Signs

• Mental status



Level Of Consciousness (LOC) or level of

responsiveness evaluated using AVPU

scale.

• A

lert

• V

erbal, responsive to verbal stimuli

• P

ain, responsive only to painful stimuli

• U

nresponsive, unconscious, or

(28)

Vital Signs

• Baseline vital signs



First set of vital signs obtained

• 

_{Comparing multiple sets of vital signs}

from same patient over time

• Careful analysis of vital signs can alert

you to current or developing problems.

(29)

Vital Signs

• Respiration



Act or process of breathing in (inhaling)

and out (exhaling)

• Evaluate



Rate, depth, sound, ease

• Work of breathing

(30)

(31)

Vital Signs

• Respiratory assessment



Grasp patient's wrist as if you were

going to count pulse rate.



Hold his arm firmly against his upper

abdomen.



Observe abdomen and chest move in

and out.



Listen for abnormal sounds.

(32)

Vital Signs

• Respiratory assessment



Count number of breaths patient takes

in 15 or 30 seconds.



While counting respirations, note depth

and ease of breathing.

(33)

(34)

Figure 12.3a

Emergency Medical Responder assessing respirations on a supine patient.

(35)

(36)

Vital Signs

• Pulse



Remote heartbeat



Gives insight into circulatory status of

patient



Good pulse indicates blood is moving

well throughout body.

(37)

Vital Signs

• Pulse



Central pulses

• Carotid, femoral



Peripheral pulses

(38)

(39)

(40)

Vital Signs

• Pulse



Assess for rate, strength, rhythm.

• Responsive patient



_{Check radial pulse.}

• Unresponsive patient



_{Check carotid pulse.}

(41)

Vital Signs

• Pulse rate for adults is between 60 and

100 beats per minute.



_Tachycardia

• Rate above 100



Bradycardia

• Rate below 60

• Pulse point for infants under the age of

(42)

Vital Signs

• Capillary refill



Time it takes for capillaries to refill after

being blanched



Select appropriate finger or toe.



Using thumb and index finger, squeeze

pad of finger or toe from both sides.

Observe pad as it blanches.

(43)

Vital Signs

• Capillary refill



Quickly release pressure.

• Observe color return to pad.

(44)

(45)

Vital Signs

• Blood pressure



Measurement of pressure of blood

against walls of arteries, both when

heart beats and when it is at rest



Systolic

• Pressure within arteries when heart beats

• Contraction phase of heart

(46)

Vital Signs

• Blood pressure



Diastolic

• Pressure that remains in arteries when

heart is at rest

(47)

Vital Signs

• Reading of 120/80 considered normal

blood pressure

• Take several readings to identify

changes in status.

• Systolic reading above 140 considered

(48)

(49)

Blood Pressure Assessment Video

Click on the screenshot to view a video on the topic of taking blood pressure.

(50)

Vital Signs

• Auscultation



Listening to internal sounds of the body

with a stethoscope



Have patient sit or lie down.



Remove clothing on arm.



Support arm at level of heart.

(51)

(52)

Figure 12.7a

Proper position for taking a blood pressure while seated.

(53)

(54)

(55)

(56)

(57)

Vital Signs

• Auscultation



Let rest of air out of cuff quickly.

(58)

12.1.1 Place the cuff snugly around the upper arm.

(59)

(60)

Vital Signs

• Auscultation



Close valve and inflate cuff.

• 180 mmHg adult

• 120 mmHg child



_{Open valve slowly to release pressure}

from cuff.



Listen carefully as you watch needle

move.

(61)

12.1.3 Quickly inflate the cuff then release the pressure to obtain the blood pressure readings.

(62)

(63)

Vital Signs

• Palpation



Using one's hands to touch or feel the

body.



Not very accurate method



One reading

• Approximate systolic pressure



Used when there is too much noise,

making it difficult to hear via

(64)

12.2.1 Place the cuff and locate the radial pulse prior to inflating the cuff.

(65)

12.2.2 Inflate the cuff until you feel the radial pulse go away.

(66)

12.2.3 Continue inflating the cuff to approximately 30mm Hg beyond where the pulse went away.

(67)

(68)

Vital Signs

• Skin signs



Evaluate color, temperature, and

moisture.



Pale or cyanotic



Flushed



Jaundiced

(69)

Vital Signs

• Skin signs



Examples of skin signs

• Pink, warm, dry (PWD)

• Pale, cool, moist

• Flushed, hot, moist

(70)

(71)

(72)

Vital Signs

• Evaluate skin color in dark-skinned

patients



_{Oral mucosa}



Conjunctiva



Nail beds



Palms

(73)

Vital Signs

• Pupils



Note general condition.



Identify any obvious injury or deformity.



Ensure both pupils are round and same

size.



Note reaction to changes in light.

• Constriction with sudden introduction of

light

• Dilation when light to pupil is blocked

(74)

Vital Signs

• Pupils



PERL stands for:

• P

upils

• E

qual

• R

eactive

(75)

(76)

(77)

Think About It

• Could vital signs ever be considered

unreliable?

• What does "treat the patient, not the

(78)

(79)

Summary

• Good patient assessment



Gathering information (history) about

patient and chief complaint and

obtaining complete and accurate vital

signs

• Properly introduce yourself and get

patient's name right away.

• Whenever possible, direct your

questions to patient.

(80)

Summary

• Speak clearly and confirm that patient

hears, understands, and answers each

question before asking another.

• Utilize SAMPLE tool to help guide

questions, and always document

patient's answers.

• Obtain set of vital signs to establish

good baseline.

(81)

Summary

• Repeat vital signs and compare to

previous readings to establish trends in

patient's condition.

• Most vital signs have multiple

characteristics.

(82)

(83)

Review Questions

1. Why is it important to obtain a

thorough medical history?

2. What is the difference between a sign

and a symptom?

3. What does SAMPLE represent?

4. What does OPQRST represent?

5. What role does monitoring vital signs

play in the overall assessment and care

of the patient?

(84)

Review Questions

6. What are the methods used to assess

each of the five vital signs?

7. What vital information is obtained

through assessing respirations, pulse,

blood pressure, skin signs, and pupils?

(85)

Review Questions

8. How do the techniques used to assess

a pulse in an infant, child, and adult

patient differ?

9. How do normal and abnormal vital

(86)

Practical Assessment

• You will be given a class roster that

contains each student's name and a

column for each vital sign.

• Obtain vital signs on three students.

• Continue this activity at the beginning

of every class until you have obtained

vital signs from every other student in

class.

(87)

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ch12 lecture

Emergency Medical Responder

Emergency Medical Responder

First on Scene

First on Scene

CHAPTER

TENTH EDITION

Obtaining a Medical

History and Vital Signs

Objectives

1.

Define the following terms:

a.

Auscultation

b.

Baseline vital signs

c.

Blood pressure

d.

Capillary refill

e.

Chief complaint

f.

Cyanotic

g.

Diaphoretic

h.

Diastolic

Objectives

1.

Define the following terms:

i.

Medical history

j.

Mental status

k.

OPQRST

l.

Palpation

m.

Pulse

n.

Respiration

o.

SAMPLE history tool

p.

Sign

Objectives

1.

Define the following terms:

q.

Stethoscope

r.

Symptom

s.

Systolic

t.

Trending

u.

Vital signs

v.

Work of breathing

Objectives

2.

Explain the importance of a thorough

medical history.

3.

Differentiate between a sign and a

symptom.

4.

Describe the components of the

SAMPLE history tool.

5.

Describe the components of the

OPQRST assessment tool.

Objectives

6.

Explain the role that monitoring vital

signs plays in the overall assessment

and care of the patient.