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Vital Signs
- 1. Dr Asma Lashari Universityof Health Sciences Lahore, Pakistan
- 2. A Patient'sVital Signs include: 1. Respiration 2. Pulse 3. Temperature 4. Blood pressure 5. Pulse Oximetry (noninvasive and painless test that measures your oxygen saturation level) 6. Pupils 7. Pain Assess and monitor most vital signs by Looking, Listening and Feeling.
- 3. Wristwatch CountSeconds Penlight Examine Pupils Stethoscope Respiration and Blood Pressure Pen and notebook Take Notes Blood Pressure Cuff (Sphygmomanometer) Measure B/P Establish Baseline Vital Signs. Measure Changes Over Time. ◦ Pulse on initial reading is 80 and later becomes 120. ◦ Indicates Possible Serious condition developing.
- 4. ◦ Infant: Under1 year. ◦ Child: One to 8 years. ◦ Adult: 9 years and Older.
- 5. Regular Breathing ◦Respirations are all the same frequency and depth (shallow or deep breathing). Irregular Breathing ◦ Frequency or Rate is different. Obstructed airway ◦ Snoring or Wheezing Abnormal Breathing Conditions ◦ Poor rise and fall of the chest ◦ Increased effort ◦ Cyanosis
- 6. Age Group RespirationsPer minute ◦ Infant 25-50 Rpm ◦ Child 15-30 Rpm ◦ Adult 12-20 Rpm To count Respirations: count the number of times the Chest or Abdomen rises and falls in 30 seconds, then multiply by 2. Pretend to count pulse or do something so the patient is unaware and breathing naturally.
- 7. Tachypnea: RespiratoryRate higher than 20. ◦ Causes Anxiety, Pain, Excitement, or Acidosis. Bradypnea: Rate less than 10 ◦ Always a cause for alarm in injured Person. ◦ Causes; Head Injury or Opioid overdose. Slow Respiratory rates require additional evaluation and possibly ventilatory assistance. Cheyne-Stokes Respiration: ◦ Characterized by increased Rate and Depth followed by a period of apnea. ◦ This pattern is a sign of significant brain injury.
- 8. Radial arteryat the wrist is common site for checking pulse. An accurate pulse rate requires counting the rate for at least 30 seconds. Very slow or fast rates may require a full minute to obtain an accurate pulse rate. Normal Pulse Rates ◦ Age Group Pulse Rate per minute ◦ Infant 100-160 ppm ◦ Child 70-150 ppm ◦ Adult 60-100 ppm
- 9. Strong Weak ◦May indicate Inadequate Tissue Perfusion. Regular Irregular ◦ Sinus Arrhythmia, Premature Beats or Atrial-Fibrillation. Girls tend to have slower Pulse Rates than boys. Higher than 100: Tachycardia. lower than 60: Bradycardia. Higher than 150: Supraventricular Tachycardia.
- 10. If Heat/Cold Illness is suspected, it is important to take Temperature measurement. Method: Place the back of your hand against the Patient's Skin. This is called Relative Skin Temperature. It is not an exact measurement, but can tell you if it is high or low. Normal temperature for a healthy person at rest is 98.6°F (37°C).
- 11. Blood pressureis the Force Exerted against the walls of arteries as blood is flowing through them during a cardiac cycle. Systolic Blood Pressure: 120-140 mmHg Diastolic Blood Pressure: 60- 85 mmHg Maximum Heart Rate: 220-Age
- 13. Blood VesselsConstricting Factors ◦ Cold environment, Stress, Pain. ◦ Smoking, Decongestants. Decreasing Factors ◦ Heart failure, Trauma or Shock. Other Factors ◦ Not hearing accurately. ◦ Placing stethoscope improperly. ◦ Wrong size cuff. ◦ Arm not at the heart level. ◦ Deflating the cuff too fast.
- 14. Relatively newbut, perhaps the most important monitor available. Operates under the principle ◦ Oxygenated Hemoglobin and Deoxygenated Hemoglobin absorb Infra-Red and Red Light differently. Oxyhemoglobin absorbs infrared light at 990 nm Deoxyhemoglobin absorbs red light at 660 nm. The expected value for a healthy nonsmoker: ◦ Range of 95% to 100%. ◦ Values less than 90% require attention or supplemental oxygen.
- 15. Pulse oximeter showingthe Oxygen Saturation and Pulse rate. The Radial Pulse must match the Pulse Rate on the Oximeter to be considered Accurate.
- 16. Normal Responses: ◦Pupils Constrict with Exposure to Light and Dilate with less light. ◦ Both pupils should be the same size unless a prior injury or condition has changed this. ◦ To assess, shine a penlight into the eyes. ◦ If outdoors, cover the eyes and assess for Dilation. Abnormal findings: ◦ No Reaction to light, pupils remain Dilated or Constricted or unequal Pupils. ◦ Possible causes: Drug overdose, head injury or stroke.
- 17. Although notyet widely acknowledged, many consider assessment of pain as the newest vital sign. The easiest method of pain assessment is to ask the person to rate his/her pain on Visual Analogue Scale of 0 to 10. ◦ Zero meaning no pain and 10 meaning Worst Pain ever Felt.
- 18. Skin Colorationcharacterized by: ◦ Paleness Shock, Heart attack, emotional stress, fright, fainting. ◦ Redness High blood pressure, sunburn, heatstroke, infectious disease. ◦ Blueness Shock, MI, Poisoning ◦ Yellowness Liver disease Skin Condition ◦ Reported as Dry, Moist or Wet with respect to local environment.
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- 20. Remember differencesbetween a medical and a trauma patient. For Trauma Patient Physical Exam First. For Medical Patient, Take a history First. To conduct Patient History use S.A.M.P.L.E. ◦ S = Sign and Symptoms ◦ A = Allergies (medications, food, environment) ◦ M = Medication (current medications to identify medical condition) ◦ P = Past History ◦ L = Last oral intake (in unresponsive or confused patient, if needs immediate surgery) ◦ E = Events (activities prior to event)
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- 22. A patientmay in stable or unstable condition. Assessment process must be ongoing until next level of care arrives, with following: ◦ Every 5 minutes for unstable. ◦ Every 15 minutes for stable patient. Reassess LOC. (level of consciousness) Reassess ABC. Reassess Skin Tem, Color & Condition. Any part of Physical Exam, Important. Reassess interventions and their effects.
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- 24. When relievedof the patient by a higher level care provider, appropriate information about the patient is given. Hand-off Report (Patient Transfer Information) includes the following eight areas of information: 1. Patient Age/Sex 2. Chief complain 3. Level of responsiveness 4. Airway state 5. Breathing state 6. Circulation state 7. Physical examination findings 8. Treatment.