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Chapter 9
Vital Signs and
SAMPLE History
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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.)
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*KNOWLEDGE AND ATTITUDE
• 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.)
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*KNOWLEDGE AND ATTITUDE
• 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.)
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*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.
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Baseline
Vital Signs
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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.)
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Pulse
Respirations
Skin
Pupils
Blood Pressure
Baseline Vital Signs
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0
30
Count for 30 seconds
Multiply by 2
Example: 40 x 2 = 80
Pulse
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Adults generally 60–100/minute
Tachycardia is pulse more than
100/minute.
Bradycardia is pulse less than
60/minute.
Pulse Rate
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Strong or weak
Regular or irregular
Pulse Quality
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Carotid Pulse
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Brachial Pulse
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Radial Pulse
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Count for 30 seconds
Multiply by 2
Example: 6 x 2 = 12
Respirations
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Normal
Shallow
Labored
Noisy
Respiratory Quality
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Check Skin Color, Temperature,
and Condition
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Pale
Cyanotic
Flushed
Jaundiced
Abnormal Skin Colors
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Hot
Cool
Cold
Abnormal Skin Temperature
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Wet
Very dry
Abnormal Skin Condition
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Infants and Children: Check
Capillary Refill
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Pupils
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Abnormal Pupil Conditions
Constricted pupils
Dilated pupils
Unequal pupils
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Size
– Dilated
– Constricted
Equality
Reactivity
– To light
– Nonreactive (fixed)
Pupils
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Blood pressure measurement
normally includes two readings:
– Systolic
– Diastolic
Measured by a sphygmomanometer
– Measured in millimeters of mercury
(mmHg)
Blood Pressure
(cont.)
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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.
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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.
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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
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Auscultating
Blood Pressure
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Auscultating Blood Pressure
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Palpating
Blood Pressure
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Palpating Blood Pressure
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Noninvasive Blood Pressure
Device
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Measures oxygen circulating in the
blood
Results:
– 96–100% = normal
– 91–95% = hypoxia
– 86–90% = significant hypoxia
– < 85% = severe hypoxia
Pulse Oximetry
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Pulse Oximeter
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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
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Do not withhold oxygen from a patient
who may need it because the oximeter
reads “normal.”
Pulse Oximetry
Note
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Stable patient (every 15 minutes)
Unstable patient (every 5 minutes)
Reassessment of Vital Signs
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SAMPLE
History
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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
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Signs: smell, see, feel, hear
Symptoms: cannot observe—patient tells you
Signs and Symptoms
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To medications
To foods
To environment
Allergies
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Medications
Prescription and over-the-counter
– Current
– Recent
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Pertinent Past History
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
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Last Oral Intake
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
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Sequence of events that led to
illness or injury
Events Leading to Illness
or Injury
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
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Position yourself appropriately.
Identify yourself.
Speak in a normal voice.
Use your patient’s name.
Interview Strategies
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
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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
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
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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.)
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
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Ideally, what should the patient
history include?
What other patient history
information should be obtained?
Street Scenes
(cont.)
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Limmer et al., Emergency Care, 11th Edition
© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
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Should you take another set of vital
signs?
How might you get the patient to
rethink her decision not to be
transported?
Street Scenes