Fire Explorers
Vital Signs and Patient History
General information
 assess patient and environment
 patient’s age, sex, race, and chief complaint
Respirations
 Count the number of rise and falls of chest for 30 seconds, then multiply by 2
 Adults: 12-20 Breaths per minute
 Children: 15-30 Breaths per minute
 Infants: 25-50 Breaths per minute
 Breathing assessed by both rate and quality
 Quality is described as follows:
o Normal: there is average chest wall motion, with no use of accessory
muscles. Breathing is neither shallow nor deep
o Shallow: there is slight chest or abdominal wall motion
o Labored: there is increased breathing effort, grunting, and use of accessory
muscles. Nasal flaring is present, along with possible gasping, and
supraclavicular and intercostal retractions in infants and children
o Noisy: there is an increase in the sound of breathing, which my include
snoring, wheezing, gurgling, stridor, and crowing
 Watch breathing rhythm
o Rapid, shallow respirations can indicate shock
o Very deep, rapid respirations in an unconscious patient with head trauma
can indicate severe injury
o Deep, gasping, labored, and noisy breathing can indicate a partial airway
obstruction, respiratory failure, or chronic lung disease
o Little or no movement of the chest and abdomen can indicate respiratory
depression or arrest
o Inability to cough or talk can indicate choking
 Coughing up sputum
o Sputum is a matter that is coughed from the lungs
o Blood or frothy (foam-like) sputum can indicate and injury to the chest
o Frothy pink sputum can indicate congestive heart failure
o Thick sputum can indicate pneumonia or bronchitis
o Should note the volume, color, and other characteristics of sputum
Pulse
 Pressure wave that is felt as the heart contracts and propels blood through the
arteries
 Find pulse by palpating (feeling) an artery close to the surface of the skin
o Radial (wrist) pulse for patient > 1 years old
o Brachial (underarm) pulse for patient < 1 years old
o Carotid (neck) pulse is easier and faster to find in emergency situation
 Count the number of beats for 30 seconds, then multiply by 2
 Adults: 60-100 beats per minute
 Children: 80-100 beats per minute
 Toddlers: 100-120 beats per minute
 Newborns: 120-140 beats per minute
 Rhythm
o Skipped beats or irregular rhythm can indicate a heart rhythm problem
Skin Characteristics
 Color
o Look at nail beds, oral mucosa, and lining of eyelids for skin color on
adults
o Look at palms of the hands and soles of the feet for skin color on infants
and children
o Abnormal colors:
 Flushed (red)
 May indicate hypertension, fever, CO poisoning, alcohol
intoxication, or heatstroke
 Pale (white, ashen, or grayish)
 Insufficient circulation
 May indicate shock, or cold exposure
 Cyanotic (blue-gray)
 Poorly oxygenated blood
 Lack of oxygen and needs respiratory treatment
 Jaundice (yellow)
 Chronic illness, liver disease, hepatitis
 Pigments from liver and gastrointestinal tract are deposited
in the patient’s skin
 Temperature
o Abnormal temperatures
 Hot, cool, or cold
o Cool and damp
 Can indicate nervousness, blood loss, shock, or severe pain
o Cool and dry
 Can indicate exposure to cold
o Hot and dry
 Can indicate fever or reaction to excessive heat
 Moisture
o Normal skin is dry
o Abnormal skin is wet, moist or excessively dry and hot
 Capillary Refill
o Tests the circulatory systems ability to restore blood to the capillary blood
vessels
o Squeeze fingertip and watch capillaries refill in the nail bed
o Should be prompt and pink, returning within 2 seconds
o May not be accurate if patient has been exposed to cold conditions
Pupils
 Normally regular in outline and usually about the same size
 To assess pupils, briefly shine a light into the patient’s eyes and determine the
pupils’ size and reactivity
 Terms:
o Dilated – very large
o Normal
o Constricted – small
o Equal or unequal to each other
o Reactivity
 If the pupils change or don’t change when exposed to light
 If the pupils react equally or unequally
 Unequal pupils could indicate head injury or stroke
 Dilation of both pupils may indicate a relaxed or unconscious state
o If dilation occurs rapidly (within 30 seconds), it could be an indication of
cardiac arrest
 Constricted pupils could indicate head injury or previous drug use, even in
patients with cardiac arrest
 Failure of pupils to constrict when light is presented may indicate poisoning, drug
overdose, or injury
 In death, pupils are widely dilated and fail to respond to light
Blood Pressure
 Defined as the pressure of the circulating blood against the walls of the arteries
 Should be taken on all patients older than three years old
 Blood pressure can fall greatly after severe bleeding, following a heart attack, or
in other states of shock
 Low blood pressure indicates that there is not enough pressure to supply blood to
all the organs of the body
o This can lead to severe damage to bodily organs
 High blood pressure may damage or rupture vessels
 Always ask the patient if they have abnormal blood pressure conditions
Systolic and Diastolic Pressures
 Systolic is the measurement of the pressure exerted on the walls of the arteries
during contraction of the heart
 Diastolic is the measurement of the pressure exerted on the walls of the arteries
while the left ventricle of the heart is at rest (not pumping)
 Systolic pressure represents the maximum amount of pressure exerted on the
arteries, and diastolic represents minimum pressure that is always present on the
arteries