Vital and Diagnostic Signs

Transcription

1 GENERAL The four vital signs and the five diagnostic signs evaluated during patient assessment provide valuable information to the care provider, and when recorded properly, to the receiving facility/personnel. Vital signs are the evaluations of the functions that are... well, vital... to life. The diagnostic signs provide information for determining of potential injuries or deficits in the systems of the body. Although vital and diagnostic signs, individually, may indicate important things about the patient, the following formula reflects the primary way of determining underlying problems in a given patient: 's (Changes over time!) The only way that this formula works is for the care provider to give serial patient care. Serial patient care is constant re-evaluation of the patient's condition, signs/symptoms, and vital/diagnostic signs. The interval in which these are checked is dependent on the individual patient treatment requirements. DEFINITIONS victim patient sign symptom a person who has had an accident or became ill. a victim who is being given medical care. something you sense (see, hear, feel, or touch) related to the patient's condition. something you are told by the patient or bystanders related to the patient's condition. EMT-Basic Page 1 of 7

2 VITAL SIGNS The four vital signs are as follows: pulse rate, rhythm, and quality; respiratory rate, rhythm, and quality; blood pressure; and temperature. The name reflects the importance of these signs, as all four relate to metabolism and perfusion. The Four Vital Signs Pulse Respiration Blood Pressure Temperature The pressure wave that can be felt as the blood moves through and expands the arteries during the contraction of the heart. The process of bringing oxygen in and taking carbon dioxide out. In terms of vital signs, this is one inhalation and exhalation together. the pressure exerted on the walls of the arteries by the blood. This is measured when the heart contracts ("systolic") and relaxes ("diastolic"). measured in either Fahrenheit or Celsius. In the clinical sense, this is measured by thermometer. In the outdoor setting, this is done by assessing patient skin temperature. Pulse assessment palpated (felt) where an artery runs across a bone or other hard structure of the body and is close to the surface of the skin auscultated (heard) with stethoscope listening to the valves of the heart common assessment points (palpation) radial artery - inside of wrist near thumb carotid artery - in neck between trachea and large group of neck muscles brachial artery - inside of arm at elbow femoral artery - groin region where leg bends at hip dorsalis pedis - top of the foot common assessment points (auscultation) head of stethoscope place in intercostal space between 4th and 5th ribs on left side of chest just lateral of sternum EMT-Basic Page 2 of 7

3 Pulse (cont.) rate number of waves (beats of heart) per minute count number of pulses for 15, 30, or 60 seconds take number of beats and multiply, as necessary, to get total number in one minute if 15 secs, take number and multiply by 4 if 30 secs, take number and multiply by 2 rhythm interval of beats may be regular or irregular if irregular, assessment must be a full minute quality the character of the beat, that is, how it feels may be strong, weak, thready (real light and drawn out), bounding (pounding), or absent averages - used for testing... remember to evaluate signs and symptoms for problems adults (8 yoa and up) between bpm concern if less than 60 or more than 100 children (1-8 yoa) between bpm concern if less than 60 or more than 100 infants (neonates to 1 yoa) between bpm concern if less than 80 or more than 160 Respirations Assessment of respirations is done by counting the number of breaths a patient has in one minute. This assessment is somewhat difficult in that the patient must not be aware of your counting as it tends to alter the breathing patterns of your patient. Listed below are some hints for assessing respirations: 1. Use body position. Place the patient's arm across their abdomen or chest while assessing the pulse and just continue looking at your watch and holding the wrist and assess breathing. You may also place your hand on the patients shoulder or rearrange loose clothing to provide better assessment. Don't forget to watch your patient's nose, mouth, or neck for breathing. 2. Breath with your patient to help count. 3. Listen to breathing with a stethoscope on the chest. This is extremely useful on infants and small children. EMT-Basic Page 3 of 7

4 Respirations (cont.) rate number of respirations (inhalation and exhalation) per minute count number of breaths for 15, 30, or 60 seconds take number of respirations and multiply, as necessary, to get total number in one minute if 15 secs, take number and multiply by 4 if 30 secs, take number and multiply by 2 rhythm may be regular or irregular note irregular pattern and determine if it is a specific type (i.e. Cheyne-Stokes, Biots, Kussmaul, etc.) quality the character of the breathing - the depth and description of process may be deep, shallow, wheezing, labored, or absent averages - used for testing... remember to evaluate signs and symptoms for problems adults (8 yoa and up) between resp. per minute concern if less than 10 or more than 30 children (1-8 yoa) between resp. per minute concern if less than 12 or more than 40 infants (neonates to 1 yoa) between resp. per minute concern if less than 30 or more than 70 Blood Pressure The blood pressure is the force the blood exerts against the walls of a vessel. The blood pressure is measured in arteries utilizing a sphygmomanometer, or blood pressure cuff ("BP cuff"). The BP cuff measures pressure in millimeters of mercury, abbreviated "mmhg". There is a pressure associated with the contractile phase (systole) and the relaxation phase (diastole) of the heart muscle. The measurement of blood pressure can give one or both of the values, with the technique utilized determining which reading is acquired. The two techniques are auscultation (listening) and palpation. The auscultation technique is preferred as it provides both the contractile pressure, known as systolic pressure, and the relaxation pressure, known as diastolic pressure. The palpation technique is utilized when hearing is difficult, but only provides the systolic blood pressure. NOTE: The BP cuff has a pressure gauge used to read pressures. This gauge is marked in small increments of 2 mmhg on the dial. Assessment of a blood pressure should not involve any odd numbers for blood pressures unless assessed by an electronic device. Pressures are read as "<systolic> over <diastolic>" or "<systolic> over p" ("<systolic> by palpation"). Averages are: Adult Males: diastolic = 65 to 90 mmhg systolic = 100 plus age (up to 40) mmhg; Adult Females: 10 points less than males EMT-Basic Page 4 of 7

5 Blood Pressure (cont.) assessment auscultation - listening to turbulent pulse wave created by pressure on artery procedure - uses BP cuff and stethoscope 1. BP cuff is placed over artery, usually brachial artery (may be femoral) 2. stethoscope is placed on artery distal to cuff... leave in place until the cuff is completely deflated in step cuff is inflated slowly while listening for pulse wave... gauge is being watched 4. pulse wave will be heard... continue inflation until sound disappears 5. inflate cuff 30 mmhg above pressure at which sound disappeared 6. slowly deflate cuff (2-3 mmhg per second) 7. the first pulse wave heard will be systolic pressure... the number will be recorded from the gauge 8. continue to deflate... sound may change in volume and character the last pulse wave heard will be the diastolic pressure... the number will be recorded from the gauge 10. completely deflate cuff and wait 2 minutes before attempting another blood pressure (clinical application) palpation - feeling pulse wave distal to BP cuff procedure - uses BP cuff 1. BP cuff is placed over artery, usually brachial artery (may be femoral) 2. pulse point is located distal to cuff... once located, do not move from pulse until cuff is completely deflated at step #8 3. cuff is inflated slowly while feeling pulse wave... gauge is being watched 4. pulse wave distal to cuff disappears 5. inflate cuff 30 mmhg above pressure at which pulse disappeared 6. slowly deflate cuff (2-3 mmhg per second) 7. the first pulse wave felt distal to cuff will be systolic pressure... the number will be recorded from the gauge 8. completely deflate cuff and wait 2 minutes before attempting another blood pressure (clinical application) Temperature Temperature relates to the assessment of skin temperature by touch. This is done by placing the back of your hand or forearm on the patient's forehead. It is assessed in relative terms: warm, hot, cool, cold, or clammy. True body temperature is sometimes assessed as oral, rectal, or axillary (armpit) in degrees Fahrenheit or Celsius. EMT-Basic Page 5 of 7

6 DIAGNOSTIC SIGNS There are five diagnostic signs used in evaluating your patient. These signs includethe following: level of consciousness, skin moisture/color, eye condition, the ability to feel, and the ability to move. There are numerous techniques for assessing these signs. Outlined below are a few of the most common techniques. Level of Consciousness ("LOC") will be constantly re-evaluated initially evaluated with the Alert and Oriented ("A & O") scale may be evaluated, if unable to complete A&O interview, with AVPU scale Alert & Oriented scale consistent throughout emergency medicine ask three questions, looking for three correct answers What is your name? Where are you? What is today? if patient answers all three questions, the patient is considered A&Ox3 (said A and O times three) if patient answers only one or two questions, the patient is considered A&Ox1 or 2 with explanation of what the patient is or is not oriented to... "...A&Ox2 oriented to name and place..." or "...A&Ox2 not oriented to time..." if patient is unable to answer any of the three questions (A&Ox0), assessment must be made on AVPU scale AVPU stands for Alert, Verbal, Painful, or Unresponsive refers to stimuli required to elicit a response from the patient is assessed in sequence from A to U A Alert - eyes open, aware of environment V Verbal - responds to verbal requests P Painful - responds to painful stimuli... must be done carefully U Unresponsive - does not respond to verbal or painful stimuli Skin Moisture and Color assessed with skin temperature subjective terms moisture may be dry, wet, moist, clammy (gummy bear feeling) must be evaluated with appropriate consideration for environment color is evaluated in mucosa of lips, eyelids, or nail beds on all patients may be pink, pale (pallor), ashen, cyanotic, necrotic EMT-Basic Page 6 of 7

7 Eyes assessment of response of pupils to light, the moisture of eyes, the color of sclera (the white area of eye), and the gaze of the patient pupils response when light is shown into pupils penlight or other light source is shown into pupil... the other eye is watched and evaluated pupils will constrict with more light/dilate with less light pupils should be equal and react the same to the light pupils may be equal and reactive to light ("PEARL"), unequal, dilated, constricted, sluggish, fixed, or blown use caution on seizure patients be aware of glass eyes and colored contact lenses eye glasses must be lifted away from eyes for assessment moisture - only noted if there is a deficit (no moisture) the moisture on the surface of eye assessed by looking at eyes may be dry or "lack luster" color - only noted if there is a deficit (not white) the color of sclera assessed by looking at sclera may be jaundiced, bloodshot, or pink gaze - only noted if there is a deficit (eyes pointing in different directions) direction of eyes relative to each other must consider previous history must evaluate for facial trauma assessed by looking at eyes may be disconjugate (eyes looking different directions) or offset (different position on face) Ability to Feel and Ability to Move assessed in the entire body focusing on the upper and lower extremities must not cause further harm conscious patients check sensation - ask patient if they can feel you touching (all) their fingers and toes check movement - ask patient if they can wiggle (all) their fingers and toes, assess equality of push/pulls in lower extremities and grips in upper extremities use caution with spinal trauma patients for physical and psychological reasons unconscious patients check sensation and movement by carefully running pointed object up soles of feet and in the palms of the hands and look for response in toes and fingers moving make certain to stabilize extremity prior to assessment to prevent movement of extremity that may cause more harm to underlying injury EMT-Basic Page 7 of 7