Chapter 11 Vital Signs, Monitoring Devices, and History Taking

Vital Signs

"signs of life", outward signs that give clues to what is happening inside the body

1 year or older Because in patients who are younger than 1 year old, the neck is short and stubby which makes it difficult to locate the carotid pulse--therefore use the brachial pulse

A carotid pulse can only be assessed in patients who are _________________? Why? the neck is short and stubby, making it difficult to locate the carotid pulse; thus, assess a brachial pulse

adequate tidal volume

A normal quality of breathing correlates with an _____________________.

1 year or older

A radial pulse can only be assessed in patients who are ______________________.

Kussmaul respirations

A rapid respiratory rate with a deep and labored tidal volume

Central neurogenic hyperventilation

A sustained deep and rapid respiratory rate of at least 25 breaths per minute but with a regular pattern.

• Cheyne Stokes respirations • Biot's respirations • Apneustic respirations • Ataxic respirations • Agonal respirations • Kussmaul respirations • Central neurogenic hyperventilation.

Abnormal respiratory rhythms/patterns include the following:

shallow, labored, or noisy.

An abnormal quality of breathing may be _____________, ____________, or _____________.

Ataxic respirations

An irregularly irregular pattern of rate and tidal volume.

In the trauma patient, you auscultate the lungs primarily to determine whether breath sounds are present or absent In the medical patient you are should focus on abnormal breath sounds which may include wheezing, rhonchi, and crackles (rales).

Compare how determine if Noisy respirations are present in a trauma patient versus a medical patient?

1) look at the patient and determine whether he looks to be in respiratory distress 2) assess his mental status and pay attention to his speech pattern.

How do you assess a pt's respiratory rate?

Auscultate the chest with a stethoscope to determine whether breath sounds are present on both sides and to identify any noisy breathing sounds not audible to the ear alone.

How do you determine if Noisy respirations are present?

by observing the patient's chest rise and fall

How is respiratory rate assessed?

respiratory rate or the tidal volume

If either the _______________ or the ________________ is found to be inadequate, then the patient's respiratory status is inadequate and positive pressure ventilation must be initiated.

younger than 1 year

In patients ______________________, it is difficult to locate the carotid pulse; assess a brachial pulse

Apneustic respirations

Is characterized by prolonged periods of inhalation.

• A sphygmomanometer (blood pressure cuff) in adult and pediatric sizes to measure blood pressure • A stethoscope to take blood pressure and listen to lung sounds • A wristwatch that counts seconds to measure pulse and respiratory rates • A penlight to examine pupils • A pair of EMT shears for cutting away clothing • A pen and pocket notebook for recording vital signs and other findings • Your personal protective equipment for Standard Precautions, such as protective gloves, eyewear, and face mask • A pulse oximeter to establish and monitor the oxygen saturation in the blood

List the equipment needed to measure vital signs: 1) 2) 3) 4) 5) 6) 7) 8)

Agonal respirations

Long periods of apnea with a gasping breath interposed.

Biot respirations

Similar to Cheyne Stokes except that the tidal volume doesn't change, but the respiratory pattern is interrupted by a period of apnea.

baseline vital signs

The first set of measurements you take to which subsequent measurements can be compared.

12-20, 20.

The normal respiratory rate range for an adult patient at rest is ___________ per minute, while the normal respiratory rate range for an elderly adult patient at rest is __________ per minute.

Assessment

The process of finding out what's wrong with the patient right now and what led up to the problem

rhythm, rate, and relative strength, volume of blood

The pulse directly reflects the ____________, _____________, and ___________________ of the contraction of the left ventricle of the heart and the _____________________ being pumped out of the left ventricle of the heart.

normal or abnormal

The quality of breathing may be _______________ or _______________.

tidal volume

The quality of respiration is an assessment of ____________________.

Cheyne Stokes respirations

The respiratory rate and tidal volume gradually increase and gradually decrease followed by a period of apnea for up to 10 seconds....The pattern then repeats itself.

speech, activity, emotions

The respiratory rhythm can be easily affected by __________, _____________, _______________, and other factors in the conscious and alert patient.

respiratory muscle fatigue, breathe adequately

The use of accessory muscles may lead to _________________________ and a failure in the ability of the patient to ________________________.

energy

The use of accessory muscles requires an increase in the amount of _______________ expended to breathe.

10, 26

Typically, respiratory rates that are less than ______ or greater than ______ per minute are of concern.

Mucus blocking the larger bronchioles

Upon pt examination with the use of a stethoscope, the EMT hears Rhonchi.... what is the potential cause?

Constriction (narrowing) and inflammation reducing the internal diameter of the bronchioles in the lungs

Upon pt examination with the use of a stethoscope, the EMT hears Wheezing.... what is the potential cause?

Fluid surrounding and filling the alveoli

Upon pt examination with the use of a stethoscope, the EMT hears crackles (rales).... what is the potential cause?

Fluid in the upper airway

Upon pt examination without the use of a stethoscope, the EMT hears Gurgling .... what is the potential cause?

the Tongue is partially blocking the upper airway at the level of the pharynx

Upon pt examination without the use of a stethoscope, the EMT hears Snoring.... what is the potential cause?

Partial obstruction of the upper airway at the level of the larynx

Upon pt examination without the use of a stethoscope, the EMT hears Stridor or crowing.... what is the potential cause?

the patient is losing blood.

What do the following Vital Signs indicate about the pt: a blood pressure that continues to decrease and a heart rate that continues to increase

around 90 bpm.

What is the normal heart rate per minute In an elderly patient (greater than 75 years of age)?

60-100

What is the normal heart rate per minute in a adolescent (12-15 y/o)?

60-100

What is the normal heart rate per minute in a adult?

100-180

What is the normal heart rate per minute in a infant (1 month-12 months?

100-205

What is the normal heart rate per minute in a neonate (birth-1 month)?

80-120

What is the normal heart rate per minute in a preschooler (3-5 y/o)?

75-118

What is the normal heart rate per minute in a school aged child (6-11 y/o)?

98-140

What is the normal heart rate per minute in a toddler (1-2 y/o)?

comparing each set of VS will reveal changes in the patient's condition and may indicate how effectively you are managing the patient's injury or illness, or if the patient is deteriorating.

What is the purpose of taking two or more sets of vital signs?

wheezing, crackles (rales), and Rhonchi

What noisy respiratory sounds can be heard with a stethoscope?

snoring, gurgling, and stridor or crowing

What noisy respiratory sounds can be heard without a stethoscope?

a) Do not compress too hard, which may impede circulation to the brain. b) avoid excessive pressure in elderly patients. c) Never assess the carotid pulse on both sides at the same time,

What precautions should the EMT take when palpating the carotid pulse?

assess the carotid (central) and the radial (peripheral) pulse at the same time so that there is no delay in determining whether a pulse is truly present. it also provides a quick assessment of the patient's perfusion status.

What pulse(s) should be assessed in an unresponsive patient? why is this done?

respiratory rate respiratory quality respiratory rhythm.

What vital signs are assessed to determine "respiration"?

• Respiration • Pulse • Skin • Pupils • Blood pressure • Pulse oximetry

What vital signs will the EMT measure?

older than 1 year of age

When a peripheral pulse cannot be obtained in patients ___________________________________, assess the carotid pulse.

in the Brachial artery located on the medial aspect of the arm, midway between the shoulder and the elbow between the biceps and triceps muscles.

Where is the Brachial pulse be felt?

in the Carotid artery located on either side of the neck in the groove between the trachea and the muscle mass.

Where is the Carotid pulse be felt?

in the Dorsalis pedis artery located on the top of the foot on the great-toe side.

Where is the Doralis pedis pulse be felt?

in Femoral artery located in the crease between the lower abdomen and the upper thigh (groin).

Where is the Femoral pulse be felt?

in the Popliteal artery located in the crease behind the knee.

Where is the Popliteal pulse be felt?

in the Radial artery located proximal to the thumb on the palmar surface of the wrist.

Where is the Radial pulse be felt?

in the Posterior tibial artery located behind the medial malleolus (ankle bone).

Where is the posterior Tibial pulse be felt?

pain

_______ triggers the sympathetic nervous system, causing an increase in the respiratory rate. When _______ is reduced, the respiratory rate decreases.

yes, because the pt is at rest with a HR of 98 bpm which does fall within the average range for his age group (60-100). The average 19 year old male does not have this high of a pulse rate when at rest. Investigate for other pathologies (nervous, hypoxia, loss blood, electrolyte imbalance, etc.)

a 19 y/o pt with a HR of 98 bpm is found sitting in a recliner in his living room. Should the EMT be concerned about this pt's vital signs?

yes, while a RR of 24 bpm does fall within the upper limit of the average range for their respected age, it is still high for this pt.

a 19 y/o pt with a RR of 24 bpm is found sitting in a recliner in his living room. Should the EMT be concerned about this pt's vital signs?

no, beacuse as people age, their HR's continue to increase. Therefor, an elderly pt's HR will continue to raise as they get older.

a 83 y/o pt with a HR of 98 bpm is found sitting in a recliner in his living room. Should the EMT be concerned about this pt's vital signs?

no, this is considered normal for the pt

a 83 y/o pt with a RR of 24 bpm is found sitting in a recliner in his living room with no signs of respiratory distress. Should the EMT be concerned about this pt's vital signs?

inadequate tidal volume

abnormal quality of breathing is an indication of an ______________________.

medical illness, a chemical imbalance, or brain injury

an abnormal respiratory rhythm in the patient with an altered mental status is a serious concern. It may indicate a ____________________, a ________________________, or _______________.

(1) The patient will not be able to sustain that rate for a long period because of the increase in workload to breathe and the respiratory muscle fatigue that will follow (2) the rate is so fast that the lungs don't have time to fill adequately, leading to a drastic reduction in tidal volume.

an adult patient breathing at a rate greater than 40 per minute or an infant/young child breathing greater than 60 per minute should receive assisted ventilation for two reasons:

abnormal respiratory rhythm

an irregular pattern of respiration

Not necessarily. Normal and Abnormal VS only refer to the average range that the HR is for this particular group of patients, it does not necessarily mean they have normal or abnormal HR/VS.

does a pt with bradycardia or tachycardia have abnormal vital signs?

determined by counting the breaths in a 30-second period and multiplying by 2. (One breath = one inhalation +one exhalation)

how is Respiratory rate/respirations per minute measured?

Hr is determined by feeling the pulse

how is a patients heart rate per minute measured?

inhale

in a pt with Labored respirations, the use of accessory muscles in the neck and chest usually indicates the patient is struggling to __________

exhale

in a pt with Labored respirations, the use of accessory muscles in the abdominal muscle usually indicates the patient is struggling to ________

1) any noisy breathing sounds not audible to the ear alone which may include wheezing, rhonchi, and crackles (rales).

in order for a pt to have Noisy respirations (i.e., an abnormal sound of breathing), they must display.... 1)

1) average chest wall motion, which is at least 1 inch of expansion in an outward direction. 2) no use of accessory muscles of the chest, neck, or abdomen while breathing. 3) the Rate is normal, and inhalations are neither prolonged nor excessively short. 4) Exhalation is typically twice as long as inhalation. 5) quiet breathing sounds that do not produce abnormal sounds or noises.

in order for a pt to have Normal quality of respiration, they must display.... 1) 2) 3) 4) 5)

1) only slight chest or abdominal wall expansion upon inhalation, which typically indicates an inadequate tidal volume and requires positive pressure ventilation by bag-valve device or continuous positive airway pressure depending on the patient's condition and assessment findings.

in order for a pt to have Shallow respirations, they must display.... 1)

pulse

the pressure wave generated by the contraction of the left ventricle.

The respiratory rhythm

the regularity or irregularity of respirations

artery, bone

the volume of blood being pumped out of the left ventricle of the heart can be felt at any point where an __________ crosses over a ____________ near the surface of the skin.

Noisy respirations

type of respirations where the patient displays an abnormal sound of breathing which may include snoring, wheezing, gurgling, crowing, or stridor.

Labored respiration

type of respirations where the patient is working hard to breathe

• Scene size-up • Primary assessment • Secondary assessment • Reassessment

what are the 4 components of a patient assessment?

carotid and femoral

what are the central pulses?

radial, brachial, posterior tibial, and dorsalis pedis

what are the peripheral pulses?

• To determine whether the patient is injured or has a medical illness • To identify and manage immediately life-threatening injuries or conditions • To determine priorities for further assessment and care on the scene versus immediate transport with assessment and care continuing en route

what are the purposes of the primary assessment?

• if appropriate, identify and manage immediately life-threatening injuries or conditions • To further examine the patient and gather a patient history • To provide further emergency care based on additional findings

what are the purposes of the secondary assessment?

1) the volume of air moving in and out of the lungs with each breath, 2) the volume per minute 3) how well that volume is moving.

what does the quality of respiration (or breathing) tell you?

12-20

what is the normal breathing rate per minute in a adolescent (12-15 y/o) ?

12-20

what is the normal breathing rate per minute in a adult ?

30-53

what is the normal breathing rate per minute in a infant (less than 1 y/o) ?

40-60

what is the normal breathing rate per minute in a neonate (birth- 1 month) ?

20-28

what is the normal breathing rate per minute in a preschooler (3-5 y/o) ?

18-25

what is the normal breathing rate per minute in a school aged child (6-11 y/o)?

22-37

what is the normal breathing rate per minute in a toddler (1-2 y/o) ?

it provides a measurement of heart rate and an assessment of pulse quality and rhythm.

what is the purpose of measuring pulse?

To monitor the patient's condition, assessing the effectiveness of the care that has been provided until they reach the facility and adjusting care as needed

what is the purpose of reassessment?

• To determine whether the patient is injured or has a medical illness

what is the purpose of the scene size up?