Chapter 5
Baseline Vital Signs and
SAMPLE History
Slide 1
Overview

Baseline Vital Signs

Breathing
Skin
 Pupils
 Blood Pressure
 Vital Sign Reassessment


SAMPLE History
Slide 2
Baseline Vital Signs
Slide 3
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Trending

The process of comparing sets of vital signs
or other assessment information over time
A single set of vital signs does not
provide as much information as does
a trend in the patient’s vital signs.
Slide 4
Vital Signs

Breathing

Skin

Pupils

Blood pressure
Slide 5
Breathing

Assess both rate and quality
Slide 6
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Breathing

Rate

Determined by counting the number of breaths in
a 30-second period and multiplying by 2
Care should be taken not to inform
the patient—this may cause them to
influence the rate
Slide 7
Breathing

Quality

Can be determined while assessing the rate
• Normal

Average chest wall motion, not using accessory muscles
• Shallow

Slight chest or abdominal wall motion
• Labored


An increase in the effort of breathing
Often characterized by the use of accessory muscles
• Noisy

An increase in the audible sound of breathing
Slide 8
Labored Breathing

Accessory muscles may be used during
labored breathing
Neck
muscles
Chest
muscles
Intercostal
muscles
Abdominal
muscles
Slide 9
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Labored Breathing

Retractions may indicate labored breathing
Supraclavicular
Sternal
Intercostal
Substernal
Slide 10
Breathing

Abnormal respiratory sounds






Grunting
Stridor
Snoring
Wheezing
Gurgling
Crowing
Slide 11
Pulse

Pulse points
Slide 12
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Pulse

Assess for rate and
quality
Slide 13
Pulse

Rate

Rate is the number of beats felt in 30 seconds
multiplied by 2
 Quality
• Strong
• Weak
• Regular
• Irregular
If peripheral pulse is not palpable, assess
carotid pulse
Slide 14
Pulse

Assess the brachial
pulse in infants
Slide 15
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Skin

Assess color, temperature, and condition

In patients younger than 6 years of age,
capillary refill should be evaluated
Slide 16
Skin

Color

Assessed in the nail beds, oral mucosa, and
conjunctiva
 In infants and children, use the palms of hands
and soles of feet
Slide 17
Skin

Color findings

Normal
• Pink

Normal perfusion
 Abnormal
• Pale

Poor perfusion (impaired blood flow)
• Cyanotic (blue-gray)

Inadequate oxygenation or poor perfusion
• Flushed (red)

Exposure to heat or carbon monoxide poisoning
• Jaundice (yellow)

Liver abnormalities
Slide 18
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Skin

Temperature

Assessed by placing
the back of your
hand on the patient’s
skin
 When the EMT
wears gloves, it may
be necessary to pull
the back of the glove
down to assess skin
temperature and
condition.
Slide 19
Skin

Temperature findings

Normal skin
• Warm
 Abnormal skin temperatures
• Hot

Fever or an exposure to heat
• Cool

Poor perfusion or exposure to cold
• Cold

Extreme exposure to cold
Slide 20
Skin

Condition

Normal
• Dry
 Abnormal
• Wet
• Moist
• Dry
Slide 21
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Capillary Refill




Assess capillary refill in infants and children younger than 6
years of age
Press on the patient’s skin or nail beds and determine time
for return to initial color
Normal capillary refill in infants and children is < 2 seconds
Abnormal capillary refill in infants and children is > 2
seconds
Capillary refill cannot be accurately assessed
under extreme temperature conditions.
Slide 22
Pupils

Pupils are assessed
by briefly shining a
light into the
patient’s eyes and
determining size
and reactivity
Slide 23
Pupils

Assessment findings

Size
• Dilated (very big)
• Normal
• Constricted (small)
• Equal or unequal
 Reactivity
• Reactive—change when exposed to light
• Nonreactive—do not change when exposed to light
• Equally or unequally reactive
Slide 24
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Pupils

Constricted pupils
Slide 25
Pupils

Dilated pupils
Slide 26
Pupils

Unequal pupils
Slide 27
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9
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
 Diastolic blood pressure is the point during
deflation of the blood pressure cuff at which
sounds of the pulse beat disappear
Slide 28
You might not have time to
measure the blood pressure until
the patient is en route to the
hospital.
Slide 29
Blood Pressure

Two methods of obtaining blood pressure

Auscultation
• Listen for the systolic and diastolic sounds
 Palpation
• Measured by feeling for return of pulse with deflation of
the cuff
Slide 30
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Blood pressure should be measured
in all patients older than 3 years of
age.
Slide 31
Video Clip: Measuring Blood Pressure by
Ausculatation
Slide 32
Video Clip: Palpation of Blood Pressure
Slide 33
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The general assessment of the
infant or child patient, such as sickappearing, in respiratory distress,
or unresponsive, is more valuable
than vital sign numbers.
Slide 34
Vital Sign Reassessment



Vital signs should be assessed and recorded
every 15 minutes (at a minimum) in a stable
patient
Vital signs should be assessed and recorded
every 5 minutes in the unstable patient
Vital signs should be assessed following all
medical interventions
Slide 35
SAMPLE History
S
A





M
P
L
E
Signs and Symptoms
Allergies
Medications
Past medical history
Last oral intake
Events leading to injury or illness
Slide 36
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Signs/Symptoms

Sign

Any condition, medical or trauma, that can been seen
and identified by the EMT
Bleeding, noisy breathing, and
deformities are examples of signs.
Slide 37
Signs/Symptoms

Symptom

Any condition described by the patient that cannot
be seen by the EMT
Chest pain, nausea, and shortness of
breath are examples of symptoms.
Slide 38
Allergies

Medications

Food

Environmental allergies

Consider medical identification tag
Slide 39
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Medications

Prescription




Current
Recent
Birth control pills
Nonprescription



Current
Recent
Consider medical identification tag
Be careful not to phrase this as “Do you take any drugs?” or
“What drugs do you currently take?” The word “drug” has
different meanings for different patients.
Slide 40
Pertinent Past History

Medical

Surgical

Trauma

Consider medical identification tag
Slide 41
Last Oral Intake

Solid or liquid

Time

Quantity
Slide 42
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Events Leading to Injury or Illness

Chest pain with exertion

Chest pain while at rest
Slide 43
Summary

Baseline Vital Signs

Breathing
Skin
 Pupils
 Blood Pressure
 Vital Sign Reassessment


SAMPLE History
Slide 44
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