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Assessment: Vital Signs and SAMPLE History

Level 1

Assessment of Vital Signs and SAMPLE History EMT Refresher Course EMSNeeds.com Continuing Education

Overview | Assessment | Treatment | Roles

Objectives

Vital Signs and SAMPLE History EMT Refresher Course

In this Vital Signs and SAMPLE History course you will earn 3 CE hours. This course is accredited for all levels since all EMS personnel are technically First Responders.

At the end of this course you will be able to:

  • Identify the components of scene size-up.
  • Notice common mechanisms of injury/nature of illness.
  • Explain the reason for identifying the need for additional help or assistance.
  • State the areas of the body that are evaluated during the physical exam.
  • List the components of the SAMPLE history.
  • Describe the information included in the First Responder "hand-off" report.
  • Explain the value of an initial assessment.
  • Explain the value of an on-going assessment.

References for content used by permission are on the left side under "EMS Resources." A technical :word: when clicked instantly accesses the EMS glossary online.

There are four sections: Overview, Assessment, Treatment, and Roles. Take the section tests in order by clicking the Take Test button. Your results are saved if you are interrupted. Then do the next section—no lost time or effort with mini-test sections!

EMS Course Levels
Overview

The First Responder must be able to accurately assess and record a patient's vital signs. This must be done to record trends in the patient's condition. In addition to vital signs, obtain a SAMPLE history in the event that the patient loses consciousness.

You will learn to assess mental status, the airway, if the patient is breathing and has a pulse. Identifying signs and symptoms of external bleeding and for assessing the patient's skin color, temperature, condition, and capillary refill (infants and children only) is part of the basic First Responder's training.

Asking questions to obtain a SAMPLE history and learning how to perform the physical exam and do an on-going assessment is part of assessing vitals.

Scene size-up is the first aspect of patient assessment. It begins as the First Responder approaches the scene. During this phase, the First Responder surveys the scene to determine if there are any threats that may cause an injury to the First Responder, bystanders, or may cause additional injury to the patient.

The initial assessment, physical exam, and patient/family questioning are used to identify patients who require critical interventions.

Accurately assess and record vital signs.

Definitions

  • ABC - vital signs of life or air, breathing, circulation
  • Sign - any medical or trauma condition displayed by the patient and identifiable by the First Responder, e.g., Hearing = respiratory distress, Seeing = bleeding, Feeling = skin temperature
  • Symptom - any condition described by the patient, e.g., shortness of breath
  • Perfusion - flow of fluids through the body
  • Systolic blood pressure - the top number when the heart contracts
  • Diastolic blood pressure - the bottom number when the heart relaxes.
Emergency Stop

Assessment

Gather General Information

  1. What is their chief complaint?
  2. Why was EMS notified?
  3. How old is this person? Age - years, months, days
  4. Are they male or female?
  5. What is their race?

Take baseline vital signs: ABC (air, breathing, circulation)

A Air Breathing is assessed by observing the patient's chest rise and fall. Rate is determined by counting the number of breaths in a 30-second period and multiplying by two. Care should be taken not to inform the patient, to avoid influencing the rate.
B Breathing

Quality of breathing can be determined while assessing the rate. Quality can be placed in one of four categories:

  • Normal - average chest wall motion, not using accessory muscles.
  • Shallow - slight chest or abdominal wall motion.
  • Labored - an increase in the effort of breathing.
  • Grunting and stridor. Often characterized by the use of accessory muscles with nasal flaring, supraclavicular and intercostal retractions in infants and children. Sometimes it is gasping and noisy with an increase in the audible sound of breathing and may include snoring, wheezing, gurgling, crowing.
C Circulation

Take their pulse.

Initially a radial pulse should be assessed in all patients one year or older. In patients less than one year of age, assess the brachial pulse.

If the pulse is present, assess rate and quality. The rate is the number of beats felt in 30 seconds multiplied by two. Quality of the pulse can be characterized as strong, weak, regular, or irregular.

If peripheral pulse is not palpable, assess the carotid pulse. Use caution. Avoid excess pressure on geriatric patients. Never attempt to assess carotid pulse on both sides at one time. Assess skin to determine perfusion.

Gathering information

 

 

 

 

Taking pulse

 

 

 

Pulse rate

 

Skin Assessment

Color

Assess the patient's color in the nail beds, oral mucosa, and conjunctiva. In infants and children, assess palms of hands and soles of feet.

  • Normal skin - pink
  • Abnormal skin colors
    • Pale - (lighter) indicating poor perfusion (impaired blood flow)
    • Cyanotic (blue-gray) - indicating inadequate oxygenation or poor perfusion
    • Flushed (red) - indicating exposure to heat or carbon monoxide poisoning
    • Jaundice (yellow) - indicating liver abnormalities

Temperature

  • Assess their temperature by placing the back of your hand on the patient's skin. Normal is warm.
  • Abnormal skin temperatures
    • Hot - indicating fever or an exposure to heat
    • Cool - indicating poor perfusion or exposure to cold
    • Cold - indicates extreme exposure to cold

Condition

  • Assess the condition of the patient's skin. Normal is dry. Often, abnormal skin is wet or moist.
  • Assess capillary refill in infants and children less than six years of age.
    • Capillary refill in infants and children is assessed by pressing on the patient's skin or nail beds and determining time for return to initial color.
    • Normal capillary refill in infants and children is less than two seconds.
    • Abnormal capillary refill in infants and children is greater than two seconds.
    • Give consideration to the patient’s environment, i.e., cold vs. warm temperature outside.

 

 

Pupils

Pupils are assessed by briefly shining a light into the patient's eyes, and determining size and reactivity. Check these indicators:

  • Dilated (very big), normal, or constricted (small).
  • Equal or unequal.
  • Reactivity is whether or not the pupils change in response to the light.
    • Reactive - change when exposed to light.
    • Non reactive - do not change when exposed to light.
    • Equally or unequally reactive.

Blood Pressure

  • Assess systolic and diastolic pressures.

    • :Systolic blood pressure: is the first distinct sound of blood flowing through the artery as the pressure in the blood pressure cuff is released. This is a measurement of the pressure exerted against the walls of the arteries during contraction of the heart.
    • :Diastolic blood pressure: is the point during deflation of the blood pressure cuff at which sounds of the pulse beat disappear. It represents the pressure exerted against the walls of the arteries while the left ventricle is at rest.

There are two methods of obtaining blood pressure:

  • :Auscultation: Listen for the systolic and diastolic sounds.
  • :Palpation: In certain situations, the systolic blood pressure may be measured by feeling for return of pulse with deflation of the cuff

Blood pressure should be measured in all patients older than 3 years of age.

The general assessment of the infant or child patient, (visibly sick, in respiratory distress, or unresponsive), is more valuable than vital sign numbers.

 

 

 

 

 

 

 

Take blood pressure.

 

 

 

Vital Sign Reassessment

Reassess all vital signs following all medical interventions. Then reassess and record every 15 minutes (at a minimum) in a stable patient and every 5 minutes in an unstable patient. Generally, an unstable patient is one who has high or low blood pressure.

Vital signs reassessment


Treatment

Accurate measurement and recording of vital signs over a period of time may indicate a trend in the patient's condition and be valuable in the continuum of care. There are a number of interventions that the First Responder can perform; however, these skills cannot be performed without an accurate set of baseline vital signs. The SAMPLE history is important to guide the pace of the First Responder and assist in the continuum of care at the receiving facility.

Obtain a SAMPLE history

S Signs and Symptoms
  • Sign - any medical or trauma condition displayed and identifiable with your senses such as what you:
    • Hear (respiratory distress, etc.)
    • See (bleeding, etc.)
    • Feel (skin temperature, etc.)
  • Symptom - any condition described by the patient, like shortness of breath.
A Allergies
  • Locate any medical identification tag if the patient is unresponsive. If responsive, ask about any allergies to:
    • Medications
    • Food
    • Environment
M Medications
  • Check medical id tag.
  • List prescriptions.
    • Current
    • Recent
    • Birth control pills
  • List nonprescription medications.
    • Current
    • Recent
P Pertinent Past History
  • Check the medical id tag.
  • Obtain medical information.
  • List any surgeries.
  • Identify any relevant traumas in the past.
L Last Oral Intake
  • Document solid or liquids last ingested.
    • Time
    • Quantity
E Events Leading to the Injury or Illness
  • Indicate if there was any chest pain.
    • With exertion
    • While at rest

Signs and Symptoms

Accurate measurement and recording



Roles and Responsibilities

Practice listening and identifying normal and abnormal breathing. Use a stethoscope and assess systolic and diastolic pressures.

Practice assessing rate and quality of breathing. Practice visual assessment of appropriate areas of the body to assess the color and condition (and in infants and children less than 6 years of age, the capillary refill).

Compare pupils to assess size, reactivity and equality. Practice methods for assessing breathing, obtaining a pulse, determining blood pressure, and gaining a SAMPLE history. Find the prehospital care report in your area, review the data that you are expected to report, and practice filling it out.

Practice methods for determining skin color, temperature, condition, (and capillary refill in infants and children less than 6 years of age).

Practice


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