Chapter 9 Vital Signs and SAMPLE History - · PDF fileVital signs are outward signs of ... Name the vital signs. 2. Explain why vital signs should be taken more than once. 3

Limmer et al., Emergency Care, 11th Edition

© 2009 by Pearson Education, Inc., Upper Saddle River, NJ

DOT

Directory

Chapter 9

Vital Signs and

SAMPLE History



DOT

Directory

U.S. DOT Objectives Directory

U.S. DOT Objectives are covered and/or supported by the PowerPoint™ Slide Program and Notes for Emergency Care, 11th Ed. Please see the Chapter 9 correlation below.

*KNOWLEDGE AND ATTITUDE

• 1-5.1 Identify the components of vital signs. Slide 8

• 1-5.2 Describe the methods used to obtain a breathing rate. Slide 15

• 1-5.3 Identify the attributes that should be obtained when assessing breathing. Slide 16

• 1-5.4 Differentiate between shallow, labored, and noisy breathing. Slide 16

• 1-5.5 Describe the methods to obtain a pulse rate. Slide 9, 12-14

• 1-5.6 Identify the information obtained when assessing a patient’s pulse.

Slides 9-14

• 1-5.7 Differentiate between a strong, weak, regular, and irregular pulse.

Slide 11

• 1-5.8 Describe the methods used to assess skin color, temperature, and condition (capillary refill in infants and children). Slides 17, 21

• 1-5.9 Identify the normal and abnormal skin colors. Slide 18(cont.)



DOT

Directory



• 1-5.10 Differentiate between pale, blue, red, and yellow skin color. Slide 18

• 1-5.11 Identify the normal and abnormal skin temperature. Slide 19

• 1-5.12 Differentiate between hot, cool, and cold skin temperature. Slide 19

• 1-5.13 Identify normal and abnormal skin conditions. Slide 20

• 1-5.14 Identify normal and abnormal capillary refill in infants and children.

Slide 21

• 1-5.15 Describe the methods used to assess the pupils. Slide 22

• 1-5.16 Identify normal and abnormal pupil size. Slides 22-23

• 1-5.17 Differentiate between dilated (big) and constricted (small) pupil size.

Slides 22-23

• 1-5.18 Differentiate between reactive and nonreactive pupils and equal and

unequal pupils. Slides 22, 24

• 1-5.19 Describe the methods used to assess blood pressure. Slides 25-28

• 1-5.20 Define systolic pressure. Slides 25-28

(cont.)



DOT

Directory



• 1-5.21 Define diastolic pressure. Slides 25-28

• 1-5.22 Explain the difference between auscultation and palpation for obtaining a

blood pressure. Slides 25, 29-32

• 1-5.23 Identify the components of the SAMPLE history. Slides 39-46

• 1-5.24 Differentiate between a sign and a symptom. Slide 41

• 1-5.25 State the importance of accurately reporting and recording the baseline

vital signs. Slides 6-8

• 1-5.26 Discuss the need to search for additional medical identification.

Slides 42, 44

• 1-5.27 Explain the value of performing the baseline vital signs. Slides 6-8

• 1-5.28 Recognize and respond to the feelings patients experience during

assessment. Slide 47

• 1-5.29 Defend the need for obtaining and recording an accurate set of vital

signs. Slides 6-8

• 1-5.30 Explain the rationale of recording additional sets of vital signs. Slide 38

• 1-5.31 Explain the importance of obtaining a SAMPLE history. Slides 6-8 (cont.)



DOT

Directory


*SKILLS

• 1-5.32 Demonstrate the skills involved in assessment of breathing.

• 1-5.33 Demonstrate the skills associated with obtaining a pulse.

• 1-5.34 Demonstrate the skills associated with assessing the skin color,

temperature, condition, and capillary refill in infants and children.

• 1-5.35 Demonstrate the skills associated with assessing the pupils.

• 1-5.36 Demonstrate the skills associated with obtaining blood pressure.

• 1-5.37 Demonstrate the skills that should be used to obtain information from the

patient, family, or bystanders at the scene.



DOT

Directory

Baseline

Vital Signs



DOT

Directory

Baseline Vital Signs

Vital signs are outward signs of

what is going on inside the body.

Baseline vital signs are the first

measurements you will take.

(cont.)



DOT

Directory

Pulse

Respirations

Skin

Pupils

Blood Pressure

Baseline Vital Signs



DOT

Directory

0

30

Count for 30 seconds

Multiply by 2

Example: 40 x 2 = 80

Pulse



DOT

Directory

Adults generally 60–100/minute

Tachycardia is pulse more than

100/minute.

Bradycardia is pulse less than

60/minute.

Pulse Rate



DOT

Directory

Strong or weak

Regular or irregular

Pulse Quality



DOT

Directory

Carotid Pulse



DOT

Directory

Brachial Pulse



DOT

Directory

Radial Pulse



DOT

Directory

Count for 30 seconds

Multiply by 2

Example: 6 x 2 = 12

Respirations



DOT

Directory

Normal

Shallow

Labored

Noisy

Respiratory Quality



DOT

Directory

Check Skin Color, Temperature,

and Condition



DOT

Directory

Pale

Cyanotic

Flushed

Jaundiced

Abnormal Skin Colors



DOT

Directory

Hot

Cool

Cold

Abnormal Skin Temperature



DOT

Directory

Wet

Very dry

Abnormal Skin Condition



DOT

Directory

Infants and Children: Check

Capillary Refill



DOT

Directory

Pupils



DOT

Directory

Abnormal Pupil Conditions

Constricted pupils

Dilated pupils

Unequal pupils



DOT

Directory

Size

– Dilated

– Constricted

Equality

Reactivity

– To light

– Nonreactive (fixed)

Pupils



DOT

Directory

Blood pressure measurement

normally includes two readings:

– Systolic

– Diastolic

Measured by a sphygmomanometer

– Measured in millimeters of mercury

(mmHg)

Blood Pressure

(cont.)



DOT

Directory

Blood Pressure

(cont.)

Normal systolic is usually no more

than 120 mmHg.

– Systolic greater than 140 mmHg is

considered hypertension.

Diastolic is normally 60–90 mmHg.

– Diastolic greater than 90 mmHg is

considered hypertension.



DOT

Directory

Blood Pressure

(cont.)

Adult female

– May be 8–10 mmHg lower than in an

adult male

– Hypertension is considered at same

levels as in an adult male.



DOT

Directory

Blood Pressure

(cont.)

Child 1–10 years old:

– (Child’s age x 2) + 80 mmHg

Child or adolescent older than

age 10:

– Minimum systolic of 90 mmHg



DOT

Directory

Auscultating

Blood Pressure



DOT

Directory

Auscultating Blood Pressure



DOT

Directory

Palpating

Blood Pressure



DOT

Directory

Palpating Blood Pressure



DOT

Directory

Noninvasive Blood Pressure

Device



DOT

Directory

Measures oxygen circulating in the

blood

Results:

– 96–100% = normal

– 91–95% = hypoxia

– 86–90% = significant hypoxia

– < 85% = severe hypoxia

Pulse Oximetry



DOT

Directory

Pulse Oximeter



DOT

Directory

Not accurate in shock or hypothermia

False readings in carbon monoxide poisoning

Movement and nail polish can cause inaccurate readings.

Batteries must be in good condition.

Pulse Oximeter Precautions



DOT

Directory

Do not withhold oxygen from a patient

who may need it because the oximeter

reads “normal.”

Pulse Oximetry

Note



DOT

Directory

Stable patient (every 15 minutes)

Unstable patient (every 5 minutes)

Reassessment of Vital Signs



DOT

Directory

SAMPLE

History



DOT

Directory

S = Signs and symptoms

A = Allergies

M = Medications

P = Pertinent past history

L = Last oral intake

E = Events leading to injury

or illness

SAMPLE History



DOT

Directory

Signs: smell, see, feel, hear

Symptoms: cannot observe—patient tells you

Signs and Symptoms



DOT

Directory

To medications

To foods

To environment

Allergies



DOT

Directory

Medications

Prescription and over-the-counter

– Current

– Recent



DOT

Directory

Pertinent Past History



DOT

Directory

Last Oral Intake



DOT

Directory

Sequence of events that led to

illness or injury

Events Leading to Illness

or Injury



DOT

Directory

Position yourself appropriately.

Identify yourself.

Speak in a normal voice.

Use your patient’s name.

Interview Strategies



DOT

Directory

1. Name the vital signs.

2. Explain why vital signs should be

taken more than once.

3. Explain the meaning of the letters

S-A-M-P-L-E in patient assessment.

Review Questions



DOT

Directory

What is your primary concern for

this patient?

What vital signs should be taken

even if a no transport decision is

being considered?

Street Scenes

(cont.)



DOT

Directory

Ideally, what should the patient

history include?

What other patient history

information should be obtained?

Street Scenes

(cont.)



DOT

Directory

Should you take another set of vital

signs?

How might you get the patient to

rethink her decision not to be

transported?

Street Scenes

Documents

Chapter 9 Vital Signs and SAMPLE History - · PDF fileVital signs are outward signs of ... Name the vital signs. 2. Explain why vital signs should be taken more than once. 3