VITAL SIGNS
 THESE
ARE
SIGNS
USED
BY
NURSES,
PARAMEDICS AND PHYSICIANS to follow-up
the patient's condition or to detect any variation in
them.
The vital signs include:
 Pulse
 Respiration
 Temperature
 Blood pressure
 Pupils
 Colors
 Level of consciousness
Stroke pain
 Ability to move
PULSE
 Reflects the rate of the heart beat
 Felt where an artery passes over a bone near the
surface (superficial) of the body.
 Normal heart rate ranges between 60-90/min
RESPIRATION
 It is the means by which oxygen enters the blood
through the lungs during breathing in and carbon
dioxide is expelled during breathing out.
 Normal respiratory rate is 12-16/min
TEMPERATURE
 Average body temp is 37 degrees centigrade
 Take by a clinical thermometer
BLOOD PRESSURE
 It means the force required by the heart to pump blood from
the ventricles of the heart into the arteries. It is measured in
systolic and diastolic pressure.
 Systolic- is known as the force to pump blood out of the heart
 Diastolic- is known as the resting period when the pressure
falls, also known as the relaxation period of the heart pump
 Normal B.P.
120/80 or 100/70 mm/Hg
 Hypertension: High blood pressure
 Hypotension : Low blood pressure
PUPILS
 Check the pupils for size, equality and reactivity
 Examine both eyes
COLOUR
 Color of
the skin and mucous membrane,
(conjunctiva, inside of the lips)
LEVEL OF CONSCIOUSNESS
 This is used during cardiac arrest, head injuries and
any comatose patient to assess responsiveness
REACTION TO PAIN
 in case of cardiac arrest, response to painful
stimuli can be tested
 a pin or sharper object can be used in assessing
reaction to pain
ABILITY TO MOVE
 If the patient is conscious and if spinal
or neck injury is suspected assess the
patient's ability to move his upper and
lower extremities.
PATIENT ASSESSMENT
Assessment is the cornerstone of excellent patient care.
 The first goal in assessment is to find out the patient's
condition.
 Next, all life-threatening conditions must rapidly be found
and urgent intervention and resuscitation must be initiated.
 Finally, all conditions needing attention prior to moving the
patient must be done quickly and efficiently.
Scene assessment
 Look for, identify, or remove any life-threatening
hazards if possible so as to avoid any injury to the
rescuers and any further injury to the injured.
 Failure to perform preliminary action may put your
life at risk as well as that of your patient.
Aspects of Scene Survey:
Before you approach the victim:
 Assess the scene for hazards. "Is it safe to
approach the victim?"
 Note the mechanism of injury
 Note the number of victims
 Note special equipment needed
 "Do you need additional help?"
The field of examination consists of:
 Primary Survey
 Secondary Survey
PRIMARY SURVEY
 Is a process carried out to detect life-threatening problems
 This exam should not take over 2 minutes.
 The emphasis here is on rapid evaluation and movement
to the hospital with critical patients.
The five types of the primary survey are:
 Airway and cervical Spine Control
 Breathing
 Circulation (Check pulse) and Hemorrhage Control
 Disability (Neurological Examination) -see if the patient is
alert, responds to verbal stimulus, responds to painful
stimulus and unresponsive
 Expose and Examine
SECONDARY SURVEY
OBJECTIVE: To discover medical and injury-related problems that do
not pose an immediate threat to survival but may if allowed to go
untreated.
Assessment:
 The secondary assessment is a head-to-toe evaluation of the patient.
 All related and significant injuries and identified in correlation with
the physical findings. This is accomplished on a region-by-region
basis beginning with the extremities concluding with the
neurological examination
EXAMINATION OF THE HEAD AND NECK
IN TRAUMA PATIENTS
SCALP
 Check for lacerations and contusions,
 Is there blood in the hair? Do not move the patient's head
during this procedure
 Check back of the head for blood
SKULL
 Palpate for tenderness or depression
 Pay attention to the area over the MASTOID BONE for fracture
EAR/NOSE
 Check for discharge of fluids or blood
 Clear fluid (CSF) from the nose or ears indicative of skull
fracture
EYES
 Check for trauma or swelling about the orbit
 Ecchymoses around the eyes(coon's eyes) without evidence of
direct injury are a clue to skull fracture
SCLERAE
 Check for icterus (yellowish discoloration)
PUPLIS
 Note size and shape
 Equal or unequal
 Reaction to light?
 Observe motion of the eyes
NECK
 In the trauma patient, gently palpate the back of the
neck for tenderness.
 If spinal injury is strongly suspected, immobilization
of the neck (spine) should precede all other
maneuvers of the secondary survey.
TRACHEA
 Inspect and palpate to determine whether it is in the
midline
 The trachea will deviate an obstructed bronchus from a
simple pneumothorax
 The
trachea
will
deviate
away
from
pneumothorax or significant hemothorax
a
tension
CHEST
 Check and inspect for minor deformities
 Observe movement
 check for Contusions and Abrasions
 Palpate chest cage
 Feel each rib and the clavicles individually
 Evaluation of internal structures is best done with the use of
a stethoscope.
ABDOMEN
 Look for signs of blunt or penetrating trauma
 Feel for tenderness
 If the abdomen is painful to gentle pressure…internal
bleeding
EXTREMITIES
 Examination of the extremities should begin with
clavicle (collar bone) or pelvis and proceed to the most
distal portion of that extremity
 Each bone should be individually evaluated visually for
deformation and surrounding hematoma or ecchymosis
 X-ray examination …….for fracture
NEUROLOGICAL EXAM:
 Pupil response: Are they equal or unequal?
 Eye opening: What stimuli are required to make the
patient open his eyes?
 Vocal?
 Tactile?
 Pain?
Verbal response:
Does the patient talk?
 Speech is the highest brain function
 Incomprehensible speech or an inability to speak are indications
of brain dysfunction
 Motor response: Extremity responses to stimulation can
indicate a number of things about the brain function.
These responses are either purposeful or not.
 Purposeful responses include obeying commands
CARE OF
UNCONSCIOUS
PATIENTS
CONSCIOUSNESS:
 Implies awareness and attention to one's surroundings
and to oneself.
 Consciousness is maintained by impulses mediated via
Grey Matter in the Reticular Activating System (R.A.S.)
 Sleep is a physiological process which is usually
accompanied by reduction of impulses in the R.A.S. The
individual is easily arousable from sleep and basic
protective reflexes are also intact.
UNCONSCIOUSNESS
 Unconsciousness is different from normal sleep in that
unconscious subjects are not usually arousable and
quite often, there is loss of or interference with basic
protective reflexes such as:

Maintenance of free airway

Coughing and swallowing

Withdrawal from noxious stimuli etc.
Unconsciousness may be:


Partial (semi-coma or stupor)
Complete (deep coma)
Accurate diagnosis of the cause of Unconsciousness
is important for SPECIFIC TREATMENT but
for the GENERAL CARE of the patient, level of
consciousness is more important.
CAUSES OF UNCONSCIOUSNESS
INCLUDE:
 SHOCK
 ASPHYXIA
 POISONING
 HEAD INJURY
 CEREBRO-VASCULAR ACCIDENTS (STROKE)
 EPILEPSY
 HYSTERIA
 INFANTILE CONVULSIONS
 HYPOTHERMIA OR HYPERTHERMIA
 DIABETES MELLITUS – HYPO/HYPER
 FAINTING/SYNCOPE, VASOVAGAL ATTACKS
 HEART ATTACKS
 OTHERS E.G.
- MENINGO ENCEPHALITIS
- FLUIDS AND ELECTROLYTE DISORDERS
CARE
 Emergency care or first aid
 Long term care-usually as inpatient
1- EMERGENCY CARE
General rules
 Remove the casualty from any obvious hazard and
call for help. Be aware that injury to the spine may
be present.
 Check the breathing and remove any airway
obstruction caused by flaccid tongue, food particles,
blood clots, denture etc.
 If subject is not breathing or breathing is inadequate,
commence artificial respiration immediately. This is
easier with the patient in supine position.
 Next, check the pulse and out external chest
compression if there is no pulse. In the absence of both
pulse and breathing, carry out the sequence of onerescuer CPR until help arrives.
 If both breathing and pulse are present, loosen all tight
clothing, and treat any obvious life threatening injury
such as profuse bleeding.
 Give oxygen by mask if available and elevate the legs if
the pulse is feeble or fast.
 Place and support the casualty in the semi-prone or
"tonsil" position.
 Do not leave the patient unattended unless absolutely
necessary and constantly watch the breathing and check
the pulse.
 Do not administer any oral fluids or food to an
unconscious subject.
 Keep warm with blanket if necessary but do not apply
heat.
 Remove the subject to medical aid (hospital) as soon as
possible and preferable on a stretcher.
2- LONG TERM CARE
 In order to optimize the care of the unconscious patient in a
hospital, it will be helpful to know the cause of the
unconsciousness.
 This will involve the usual steps of history taking, examination,
investigations etc.
 General care is however necessary, no matter the cause of
consciousness is important in determining the extent of care
required and may involve doctors, nurses, physiotherapists,
nutritionists etc. It may also require an intensive care unit.