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Chapter 5 – Baseline Vital Signs and SAMPLE History 1
Chapter 5 – Baseline Vital Signs and SAMPLE History
I.
DOT Objectives
Knowledge Objectives
Attitude Objectives
Skill Objectives
1. Identify the components of vital signs.
2. Describe the methods to obtain a breathing rate.
3. Identify the attributes that should be obtained when assessing
breathing.
4. Differentiate between shallow, labored and noisy breathing.
5. Describe the methods to obtain a pulse rate.
6. Identify the information obtained when assessing a patient's pulse.
7. Differentiate between a strong, weak, regular and irregular pulse.
8. Describe the methods to assess the skin color, temperature,
condition, and capillary refill (in infants and children).
9. Identify the normal and abnormal skin colors.
10. Differentiate between pale, blue, red and yellow skin color.
11. Identify the normal and abnormal skin temperature.
12. Differentiate between hot, cool and cold skin temperature.
13. Identify normal and abnormal skin conditions.
14. Identify normal and abnormal capillary refill in infants and
children.
15. Describe the methods to assess the pupils.
16. Identify normal and abnormal pupil size.
17. Differentiate between dilated (big) and constricted (small) pupil
size.
18. Differentiate between reactive and nonreactive pupils and equal
and unequal pupils.
19. Describe the methods to assess blood pressure.
20. Define systolic pressure.
21. Define diastolic pressure.
22. Explain the difference between auscultation and palpation for
obtaining a blood pressure.
23. Identify the components of the SAMPLE history.
24. Differentiate between a sign and a symptom.
25. State the importance of accurately reporting and recording the
baseline vital signs.
26. Discuss the need to search for additional medical identification.
27. Explain the value of measuring the baseline vital signs.
28. Recognize and respond to the feelings patients experience during
assessment.
29. Defend the need for obtaining and recording an accurate set of vital
signs.
30. Explain the rationale of recording additional sets of vital signs.
31. Explain the importance of obtaining a SAMPLE history.
32. Demonstrate the skills involved in assessment of breathing.
33. Demonstrate the skills associated with obtaining a pulse.
Copyright 2008, McGraw-Hill
2 Emergency Medical Technician Instructor’s Lesson Plans
34. Demonstrate the skills associated with assessing the skin color,
temperature, condition, and capillary refill in infants and children.
35. Demonstrate the skills associated with assessing the pupils.
36. Demonstrate the skills associated with obtaining blood pressure.
37. Demonstrate the skills that should be used to obtain information
from the patient, family, or bystanders at the scene.
II.
Preparation
Corresponding textbook pages:
Audiovisual equipment:
EMS equipment:
Course administration materials:
III.
Assistant instructor qualifications:
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One EMT instructor knowledgeable in
patient assessment
The instructor-to-student ratio should be 1:6
for psychomotor skill practice. Individuals
used as assistant instructors should be
knowledgeable in assessing baseline vital
signs and SAMPLE histories.
Recommended Minimum Time to Complete:
 2 hours
Initial Course:
V.
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110 to 118
Chapter 5 PowerPoint® presentation
Computer
Multimedia projector
Exam gloves
Stethoscope (dual and single head) (1:6)
Blood pressure cuffs (adult, infant, and
child) (1:6)
Penlights (1:6)
Pulse oximeter
End-tidal carbon dioxide detector
Attendance sign-in sheet
Personnel
Primary instructor qualifications:
IV.
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Key Terms Presented in This Lesson
Anisocoria Unequal pupil size that is normal in 2 to 4 percent of the population.
Arteries Large blood vessels that carry blood away from the heart to the rest of the body.
Baseline Vital Signs An initial set of vital-sign measurements.
Binaurals The metal pieces of the stethoscope that connect the earpieces to the plastic or
rubber tubing.
Capillary Refill Assessment tool used in infants and children; performed by pressing on
the patient’s skin or nail beds and determining the time for return to initial color; normal
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 3
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VI.
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capillary refill in infants and children is less than 2 seconds, delayed (greater than 2
seconds) capillary refill suggests circulatory compromise.
Central Pulse A pulse found close to the trunk of the body.
Crowing A long, high-pitched sound heard on inhalation.
Cyanosis Blue-gray color of the skin or mucous membranes that suggests inadequate
oxygenation or poor perfusion.
Diastolic Pressure The pressure in an artery when the heart is at rest.
End-Tidal Carbon Dioxide Detector A device that measures a person’s exhaled carbon
dioxide.
Gurgling The sound heard as air passes through moist secretions in the airway.
Mottling An irregular or patchy skin discoloration that is usually a mixture of blue and
white; usually seen in patients in shock, with hypothermia, or in cardiac arrest.
Objective Findings A medical or trauma condition of the patient that can be seen, heard,
smelled, measured, or felt; also called signs or clinical findings.
Patient History The part of a patient assessment that provides pertinent facts about the
patient’s current medical problem and medical history.
Perfusion The flow of blood through the body’s tissues.
Pulse The rhythmic contraction and expansion of the arteries with each beat of the heart.
Pulse Oximetry A method of measuring the amount of oxygen saturated in the blood.
Respiration The exchange of gases between a living organism and its environment.
SAMPLE A memory aid that serves to remind healthcare professionals of the information
that should be gathered when obtaining a patient history. SAMPLE stands for signs and
symptoms, allergies, medications, pertinent past medical history, last oral intake, and
events leading to the injury or illness.
Saturation of Peripheral Oxygen (SpO2) A pulse oximeter’s calculation of the amount of
hemoglobin saturated with oxygen.
Sign A medical or trauma condition of the patient that can be seen, heard, smelled,
measured, or felt; also called objective findings or clinical findings.
Snoring Sound that results from partial obstruction of the upper airway by the tongue.
Sphygmomanometer A device used to take a blood pressure.
Stethoscope An instrument used to hear sounds within the body, such as respirations.
Stridor A harsh, high-pitched sound (like the bark of a seal) that is associated with severe
upper airway obstruction and is most often heard during inhalation.
Subjective Findings A patient’s interpretation and description of his or her complaint; also
called symptoms.
Symptom A condition described by the patient, such as shortness of breath; also called
subjective findings.
Systolic Pressure The pressure in an artery when the heart is pumping blood.
Vital Signs Measurements of breathing, pulse, temperature, pupils, and blood pressure.
Wheezing A high-pitched whistling sound heard on inhalation or exhalation.
Skills Presented in This Lesson
Skill #2: Blood Pressure by Auscultation
Skill #3: Blood Pressure by Palpation
Copyright 2008, McGraw-Hill
4 Emergency Medical Technician Instructor’s Lesson Plans
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 5
VII. Lesson Outline
Slide #
1
2
3
Objective 24
Instructor Notes
A. Baseline Vital Signs and SAMPLE History
B. Objectives
C. Signs and Symptoms
1. As an Emergency Medical Technician, you must be able to accurately
assess and record a patient’s vital signs. You must also know the
difference between signs and symptoms.
2. Sign
a. A medical or trauma condition of the patient that can be seen,
heard, smelled, measured, or felt by the examiner
b. Examples
1) Unusual chest movement
2) Bleeding
3) Swelling
4) Pale skin
5) Fast pulse
6) Noisy respirations
 Because signs can be seen, heard, smelled, measured, or felt, they are considered
objective findings. Some of the ways signs (also called clinical findings) can be determined
include physical or psychological examination, laboratory tests, and imaging studies (such
as X-rays).
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3. Symptom
a. A condition described by the patient
b. Examples
1) Shortness of breath
2) Nausea
3) Abdominal pain
4) Chills
5) Chest pain
6) Dizziness
 Symptoms are subjective findings because they are dependent on (subject to) the
patient’s interpretation and description of his complaint.
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Objective 1
D. Vital Signs
1. Vital signs are measurements of breathing, pulse, temperature, pupils,
and blood pressure.
2. Measuring vital signs is an important part of patient assessment.
3. Vital signs are measured to:
a. Detect changes in normal body function
b. Recognize life-threatening situations
c. Determine a patient’s response to treatment
Copyright 2008, McGraw-Hill
6 Emergency Medical Technician Instructor’s Lesson Plans
Slide #
7
Objective 25
Instructor Notes
4. Baseline vital signs are an initial set of vital sign measurements against
which later measurements can be compared.
a. Watching trends in your patient’s condition is very important.
b. With this information and your patient assessment findings, you
will be able to recognize life-threatening emergencies, such as
shock.
 Stress to your students the importance of taking two or more sets of vital signs. Explain
that doing so will allow them to note changes (trends) in the patient’s condition and
response to treatment. For example, after obtaining the first set of vital signs (the baseline),
the EMT will be able to spot if the patient’s heart rate is increasing, staying about the same,
or decreasing when vital signs are taken a second or third time.
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5. Equipment. To take a patient’s vital signs, you will need:
a. A watch with a second hand or a digital watch that shows seconds.
The watch will be used to count your patient’s respirations and
pulse as well as to note the time of events for your documentation.
b. A penlight or flashlight. This will be used to look at your patient’s
pupils.
c. A stethoscope. A stethoscope is an instrument used to hear sounds
within the body, such as respirations. It is also used to measure
blood pressure.
d. A sphygmomanometer (blood pressure cuff) to take your patient’s
blood pressure.
e. A pen and paper to record your findings.
E. Pulse
1. Arteries are large blood vessels that carry blood away from the heart to
the rest of the body.
a. Blood is forced into the arteries when the heart contracts.
2. A pulse is the rhythmic contraction and expansion of the arteries with
each beat of the heart.
a. A pulse can be felt anywhere an artery passes near the skin surface
and can be pressed against firm tissue, such as a bone.
3. Central pulse
a. A central pulse is a pulse found close to the body trunk
b. Carotid artery
1) Major artery of the neck
2) Supplies the head with blood
3) Pulsations can be found on either side of the neck
4) To find the carotid pulse, place your index and middle fingers
in the soft hollow area just to the side of the patient’s windpipe
c. Femoral artery
1) Located in the fold between the thigh and pelvis
 Avoid excess pressure in the elderly patient. Never assess the carotid pulse on both sides
at the same time. Assessing both carotid pulses simultaneously can decrease the blood
supply to the brain and cause fainting. It can also result in severe slowing of the heart rate
because of stimulation of the vagus nerve.
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 7
Slide #
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Objective 5
Instructor Notes
 In the field, a femoral pulse is not often used because the patient’s clothing prevents easy
access to the femoral artery. To adequately feel a femoral pulse, you may have to apply
more pressure than is required at other sites.
4. Peripheral pulse
a. A peripheral pulse is located farther from the trunk of the body
than a central pulse.
b. A peripheral pulse can be felt at several locations:
1) Radial pulse
a) Located in the wrist at the base of the thumb
b) Check for a radial pulse first when assessing a responsive
adult or a child 1 year of age or older
c. Brachial pulse
1) Located on the inside of the upper arm, midway between the
shoulder and the elbow
2) Always check for a brachial pulse in an infant
d. Posterior tibial pulse
1) Located just behind the ankle bone
e. Dorsalis pedis pulse
1) Located on the top surface of the foot
5. To feel for a pulse:
a. Use the pads of your index and middle fingers, and apply gentle
pressure to the artery.
b. Count the number of beats for 30 seconds. Then multiply the
number by 2 to determine the number of beats per minute.
c. If the pulse is irregular, count it for 1 full minute.
 The pads on the tips of the finger are used because they are the most sensitive areas. Do
not use your thumb to assess a pulse – it has a pulse of its own and could be mistaken for
the patient’s pulse. If you use too much pressure, you will cut off blood flow through the
artery and will not be able to feel a pulse.
 The posterior tibial and dorsalis pedis pulses may be difficult to feel and/or may not be
palpable in well persons.
 An apical pulse is assessed by listening directly over the heart with a stethoscope. If the
pulse rate is irregular, determine the difference between the patient’s apical pulse rate and
radial pulse rate. The difference between these measurements is called the pulse deficit. The
pulse deficit is an indirect measurement of the heart’s ability to eject sufficient blood into
the peripheral circulation with each contraction.
Copyright 2008, McGraw-Hill
8 Emergency Medical Technician Instructor’s Lesson Plans
Slide #
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Objectives 6, 7
Instructor Notes
6. Pulse rate and rhythm
a. A patient’s pulse rate varies with age and physical condition
b. When feeling the pulse, note if the pulse rate is very slow, very
fast, or within the normal range for the patient’s age.
c. Also, note if the rhythm of the pulse is regular or irregular.
1) An irregular pulse is not constant.
2) A pulse with an irregular rhythm is called a dysrhythmia or
arrhythmia.
7. Normal pulse rates at rest
Life Stage
Newborn
Infant
Toddler
Preschooler
School-age child
Adolescent
Adult
Age
Birth to 1 month
1 to 12 months
1 to 3 years
4 to 5 years
6 to 12 years
13 to 18 years
18 years and older
Beats per Minute
120 to 160
80 to 140
80 to 130
80 to 120
70 to 110
60 to 100
60 to 100
 A slow heart rate may be normal in well-conditioned athletes. However, a slow heart rate
may occur because of a medical or trauma-related problem. A fast heart rate occurs as a
normal response to the body’s demand for more oxygen.
 In an adult, a rate of less than 60 beats per minute is called bradycardia, and a rate
greater than 100 beats per minute is called tachycardia.
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8. Possible causes of a slow heart rate
a. Coughing
b. Vomiting
c. Straining to have a bowel movement
d. Heart attack
e. Head injury
f. Very low body temperature (hypothermia)
g. Sleep apnea
h. Some medications
9. Possible causes of a rapid heart rate
a. Fever
b. Fear
c. Pain
d. Anxiety
e. Infection
f. Shock
g. Exercise
h. Heart failure
i. Substances such as caffeine and nicotine
j. Cocaine, amphetamines, “Ecstasy,” cannabis
k. Some medications
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 9
Slide #
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Instructor Notes
10. Pulse quality
a. Refers to the strength of the heartbeat felt when taking a pulse
b. Normal
1) Pulse is easily felt
2) Pressure is equal for each beat
3) “Strong” pulse
c. “Weak” = hard to feel
d. Weak and fast = “thready”
 An extremely strong pulse that is difficult to obliterate with pressure is called a
"bounding" pulse. A bounding pulse may be felt in patients with fever or high blood
pressure (hypertension).
 A slow, weak pulse may be felt in a patient who is suffering from hypothermia (low
body temperature). A thready pulse may be felt in a patient who is hypovolemic.
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Objective 2
F. Respirations
1. Respiration is the exchange of gases between a living organism and its
environment.
a. A single respiration consists of one inhalation and one exhalation.
2. Inspiration (inhalation) is the process of breathing in and moving air
into the lungs.
3. Expiration (exhalation) is the process of breathing out and moving air
out of the lungs.
4. During inhalation, the chest rises and oxygen is taken into the lungs.
During exhalation, the chest falls and carbon dioxide is moved out of
the lungs.
5. To count the patient’s respirations:
a. Place the patient’s arm across his chest or abdomen. Hold the
patient’s wrist as if you are assessing the radial pulse.
b. Watch the rise and fall of the chest or abdomen. Begin counting
when the chest or abdomen rises. Count each rise and fall of the
chest or abdomen as one respiration.
c. Watch to see if respirations are regular and if the chest rises
equally. Ask the patient not to speak during this time.
d. Count respirations for 30 seconds. Multiply the number by 2 to
determine the rate for 1 minute.
e. If the patient's respirations are irregular or slow, count the rate for
1 full minute.
f. In infants and young children, it is often easier to observe the rise
and fall of the abdomen to determine the respiratory rate. Count an
infant’s respirations for 1 full minute.
 Do not tell the patient you are counting his respiratory rate. If he knows that it is being
assessed, he may vary his breathing without realizing it.
 Count the patient’s pulse first. When you have finished, keep your hands in place but
shift your attention to the patient’s chest and abdomen and count his respiratory rate.
Copyright 2008, McGraw-Hill
10 Emergency Medical Technician Instructor’s Lesson Plans
Slide #
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Instructor Notes
6. Normal respiratory rates at rest
Life Stage
Newborn
Infant
Toddler
Preschooler
School-age child
Adolescent
Adult
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Objectives 3, 4
Age
Birth to 1 month
1 to 12 months
1 to 3 years
4 to 5 years
6 to 12 years
13 to 18 years
18 years and older
Breaths per Minute
30 to 50
20 to 40
20 to 30
20 to 30
16 to 30
12 to 20
12 to 20
7. Rhythm of breathing
a. Normal respirations are evenly spaced and of adequate depth.
b. Infants and young children tend to breathe less regularly than
adults do.
c. Irregular respirations may be associated with conditions such as a
diabetic emergency or head injury.
8. Shallow breathing
a. A patient is said to breathe shallowly if it is difficult to see
movement of the chest or abdomen during breathing.
b. Only a small volume of air is exchanged during shallow breathing.
 Expansion of the chest may be unequal in conditions involving trauma to the chest, such
as fractured ribs, or in certain medical conditions, such as severe pneumonia.
 Two types of breathing are usually observed. Costal (chest) breathing involves the use of
external intercostal muscles and other accessory muscles of breathing (such as the
sternocleidomastoid muscles in the neck) and is observed by the movement of the chest
upward and outward. Diaphragmatic breathing involves the use of the diaphragm and is
observed by the movement of the abdomen. Costal (chest) breathing is common in women.
Diaphragmatic (abdominal) breathing is more common in infants, children, and men.
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9. Labored breathing
a. Normal breathing is relaxed and effortless.
b. Labored breathing is an increase in the work (effort) of breathing.
If a patient is having difficulty breathing, he is usually irritable,
anxious, or restless. You may see:
1) Gasping for air
2) Excessive widening of the nostrils with respiration (nasal
flaring)
3) Use of muscles in the neck to assist with inhalation
4) Use of the abdominal muscles and muscles between the ribs to
assist with exhalation
5) “Sinking in” of the soft tissues between and around the ribs or
above the collarbones (retractions)
6) Skin color changes
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 11
Slide #
Instructor Notes
 The accessory muscles of breathing are used during periods of respiratory distress. This
use is particularly common in patients with chronic obstructive pulmonary disease (COPD)
and in infants and children. The muscles of the diaphragm and neck are used to assist in
inspiration. The muscles of the abdomen and the internal intercostals are used to assist
expiration.
 Nasal flaring is a sign of air hunger. Retractions are suggestive of an obstruction to
inspiration in the respiratory tract. The respiratory muscles "sink in" in an effort to
overcome the obstruction as the pressure within the pleura becomes increasingly negative.
 Hyperventilation is rapid, deep breathing that may normally occur because of fear, pain,
strenuous exercise, or anxiety. Kussmaul breathing is deep breathing associated with a
diabetic emergency. Hypoventilation is shallow breathing that may occur because of
narcotic overdose or pain associated with breathing (such as pleurisy, rib fractures).
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10. Abnormal respiratory sounds
a. Stridor
1) A harsh, high-pitched sound (like the bark of a seal)
2) Associated with severe upper airway obstruction
3) Most often heard during inhalation
b. Snoring
1) Results from partial obstruction of the upper airway by the
tongue
c. Wheezing
1) A high-pitched whistling sound heard on inhalation or
exhalation
2) Suggests a narrowed or partially obstructed airway
d. Gurgling
1) The sound heard as air passes through moist secretions in the
airway
e. Crowing
1) A long, high-pitched sound heard on inhalation
G. Skin Color, Temperature, and Condition
1. Assessing the patient’s skin condition can provide important
information about the flow of blood through the body’s tissues
(perfusion).
2. Perfusion is assessed by evaluating:
a. Skin color
b. Skin temperature
c. Skin condition (moist, dry)
d. Capillary refill (in infants and children younger than six years of
age)
Copyright 2008, McGraw-Hill
12 Emergency Medical Technician Instructor’s Lesson Plans
Slide #
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Objectives
8, 9, 10
Instructor Notes
3. Skin color
a. Assess the patient's skin color in the nail beds, inside the mouth,
and inside the eyelids.
b. In infants and children, assess the palms of the hands and the soles
of the feet.
c. Pale (whitish) skin
1) Occurs when the blood vessels in the skin have severely
narrowed (constricted)
2) May be seen in shock, fright, anxiety, and with other causes
d. Cyanosis, a blue-gray color of the skin or mucous membranes,
suggests inadequate breathing or poor perfusion and often appears
first in the fingertips or around the mouth.
1) Cyanosis may be seen in:
a) Respiratory distress
b) Airway obstruction
c) Cold exposure
d) Blood vessel disease
e) Shock
f) Cardiac arrest
e. Mottling is an irregular or patchy discoloration of the skin that is
usually a mixture of blue and white.
1) Mottled skin is usually seen in patients in shock, with
hypothermia, or in cardiac arrest.
f. Jaundiced (yellow) skin may be seen in patients with liver or
gallbladder problems.
g. Flushed (red) skin may be caused by:
1) Heat exposure
2) Late stages of carbon monoxide poisoning
3) Allergic reaction
4) Alcohol abuse
5) High blood pressure
 Cyanosis is of two types, depending on the level of oxygen in the arterial blood. Central
cyanosis is cyanosis of the skin and mucous membranes of the head and trunk and is most
readily observed in the oral mucosa and tongue. Peripheral cyanosis is cyanosis of the
extremities. Peripheral cyanosis occurs when blood flow to the skin decreases and may be a
normal response to a cold environment or anxiety. Cyanosis that appears around the mouth
is called circumoral cyanosis.
 Yellow skin is also associated with an increased intake of vegetables containing high
levels of carotene (carotenemia). This type of jaundice is sometimes called pseudojaundice
and can be distinguished from true jaundice by the lack of yellow discoloration of the
conjunctiva. In carotenemia, the yellow color is noted particularly in the palms, soles, and
face.
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 13
Slide #
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Objectives
11, 12, 13
Instructor Notes
4. Skin temperature
a. Assess skin temperature by placing the back of your hand against
the patient's face, neck, or abdomen.
b. Normal skin temperature is warm.
c. Hot skin may be caused by fever or heat exposure.
d. Cool skin may be caused by inadequate circulation or exposure to
cold.
e. Cold skin may be caused by extreme exposure to cold or shock.
f. Clammy (cool and moist) skin may be caused by shock, among
many other conditions.
5. Skin condition (moisture)
a. Normal skin is dry.
b. Wet or moist skin may indicate shock, a heat-related illness, or a
diabetic emergency.
c. Excessively dry skin may indicate dehydration.
 The back surfaces of the hands and fingers are used because the skin in these areas is thin
and sensitive to temperature changes.
 It is important to distinguish between generalized and localized coolness and warmth.
General coolness can result from conditions such as hypothermia. Localized coolness can
result from impaired circulation to a limb. Generalized warmth can result from heat
exposure or fever. Localized warmth can occur because of a burn or inflammatory process.
 In some situations, evaluation of the patient’s skin turgor is important. Skin turgor refers
to the elasticity of the skin. To assess skin turgor, gently pinch a small section of skin on the
patient’s forearm between your thumb and index finger. (Do not use the back of the
patient’s hand to assess skin turgor, because the skin is normally thin and loose in this area.)
The skin should quickly spring back to its previous state. If the skin stays pinched or tented
or moves back slowly to its previous state, the skin has "poor turgor." Conditions such as
dehydration are often associated with poor skin turgor.
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Objective 14
H. Capillary Refill
1. Assess capillary refill in infants and children younger than six years of
age.
2. To assess capillary refill, firmly press on the child’s nail bed until it
blanches (turns white) and then release.
a. Observe the time it takes for the tissue to return to its original
color. If the temperature of the environment is warm, color should
return within 2 seconds.
b. Other sites may be used to assess capillary refill, including the
forehead, chest, abdomen, and the fleshy part of the palm.
3. A capillary refill time of 3 to 5 seconds is said to be delayed. This may
indicate poor perfusion or exposure to cool temperatures.
4. A capillary refill time of more than 5 seconds is said to be markedly
delayed and suggests shock.
 Capillary refill is most reliable as an indicator of perfusion in infants and children
younger than 6 years of age. In adults, other factors may affect capillary refill, such as cold
weather, medications, and smoking.
Copyright 2008, McGraw-Hill
14 Emergency Medical Technician Instructor’s Lesson Plans
Slide #
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Objectives
15, 16, 17, 18
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Objectives
19, 20, 21
Instructor Notes
Pupils
1. The pupils are normally equal in size, round, and equally reactive to
light.
2. Briefly shine a light into the patient’s eyes and assess the size, equality,
and reactivity of the patient’s pupils.
a. Size
1) Dilated (very big) pupils in the presence of bright light may be
caused by trauma, fright, poisoning, eye medications, or
glaucoma.
2) Constricted (small) pupils in a darkened area may be caused by
narcotics, treatment with eye drops, or a nervous system
problem.
b. Equality
1) Unequal pupils, a condition called aniscoria, are a normal
finding in 2 to 4 percent of the population.
2) In most patients, unequal pupils suggest a head injury, a stroke,
the presence of an artificial eye, or cataract surgery on one eye.
c. Reactivity
1) Reactivity refers to whether or not the pupils change in
response to light.
2) Normally, a light that is shined into the pupil of one eye will
cause the pupils of both eyes to constrict.
3) Nonreactive pupils do not change when exposed to light. This
condition may occur because of medications or cardiac arrest.
4) Unequally reactive pupils (one pupil reacts but the other does
not) may occur because of a head injury or stroke.
J. Blood Pressure
1. Blood pressure is the force exerted by the blood on the walls of the
arteries.
2. Blood pressure is usually assessed using a blood pressure cuff and
stethoscope. This method of taking a blood pressure is called blood
pressure by auscultation because it involves the use of a stethoscope.
a. When a blood pressure cuff is applied to a patient’s arm and
inflated, blood flow in the artery under the cuff is momentarily cut
off.
b. If a stethoscope is applied over the artery, sounds can be heard that
reflect the patient’s blood pressure. As the cuff is slowly deflated,
blood flow resumes through the partially compressed artery.
3. The first sound heard is the systolic pressure. Systolic pressure is the
pressure in an artery when the heart is pumping blood.
4. As the pressure in the cuff continues to drop, a point is reached where
sounds are no longer heard because the artery is no longer compressed.
The point at which the sound disappears is the diastolic pressure.
Diastolic pressure is the pressure in an artery when the heart is at rest.
5. A blood pressure measurement is made up of both the systolic and the
diastolic pressure.
a. It is written as a fraction (116/78), with the systolic number first.
b. When reporting a blood pressure, the slash is read as "over." For
example, a blood pressure of 114/76 would be reported as "114
over 76."
I.
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 15
Slide #
Instructor Notes
 The blood pressure is recorded as an even number because most gauges have a scale
marked in increments of 2 millimeters of mercury (mm Hg). If a digital blood pressure
device is used, the readings obtained may include both odd and even numbers.
 It is helpful to record the patient’s position when a blood pressure is recorded because
the reading may change, particularly in cases of volume loss (such as dehydration,
hemorrhage) when the patient is moved from a supine to a sitting or standing position.
 Blood pressure readings between the patient's arms may vary by as much as 10 mm Hg.
35
6. Using a stethoscope
a. A stethoscope is used to listen to body sounds.
b. It consists of four major parts: the chest piece, tubing, binaurals,
and earpieces.
c. Earpieces
1) Should fit snugly but comfortably in the ears
a) For the best sound reception, the earpieces should
normally point toward the EMT’s face as the stethoscope
is put on.
2) Should be cleaned before and after use
d. Binaurals
1) Metal pieces of the stethoscope that connect the earpieces to
the plastic or rubber tubing
2) When you are using a stethoscope, the binaurals should be
angled so the earpieces remain in the ears without causing
discomfort.
e. Tubing
1) Should be flexible and 12 to 18 inches in length
2) Longer tubing decreases sound wave transmission.
f. Chest piece
1) May consist of a diaphragm and/or bell
2) Diaphragm
a) Circular, flat part at the end of the tubing
b) Has a thin plastic disk on the end
c) Used to detect high-pitched sounds, such as breath sounds
3) Should be firmly held against the patient’s skin with the
fingertips of the index and middle fingers
g. Bell
1) Some stethoscopes are also equipped with a bell
2) Has a deep, hollow, cuplike shape
3) Used to detect low-pitched sounds such as those heard during
blood pressure measurement
4) Should be lightly held against the patient’s skin, just enough to
form a seal
 When possible, the stethoscope should be placed directly on the patient’s skin because
clothing makes sounds harder to hear.
Copyright 2008, McGraw-Hill
16 Emergency Medical Technician Instructor’s Lesson Plans
Slide #
36
Objective 22
Instructor Notes
7. Blood pressure by auscultation
a. Step 1. Expose the patient's upper arm.
1) Select the correct size of blood pressure cuff for the patient.
2) Wrap the pressure cuff evenly around the patient's upper arm at
least one inch above the elbow. Place the arrow on the cuff
over the patient's brachial artery.
 When taking a blood pressure, it is important to use a blood pressure cuff of the correct
size. The width of the cuff should not be more than two-thirds the length of the patient’s
upper arm. Blood pressure readings will be wrong if the cuff is the wrong size.
37
38
39
40
41
42
43
44
45
b. Step 2. Locate the patient's radial artery.
1) Rapidly inflate the cuff until you can no longer feel the radial
pulse.
2) Inflate the cuff 30 mm Hg beyond the point at which you last
felt the pulse.
c. Step 3. Place the stethoscope in your ears.
1) Place the diaphragm of the stethoscope over the brachial artery
and hold it in place.
d. Step 4. While watching the gauge, deflate the cuff slowly and
evenly at a rate of 2 to 3 mm Hg per second.
1) Listen for sounds. The first sound is the systolic pressure and
should be near the point where the radial pulse disappeared.
e. Step 5. Continue to deflate the cuff, noting the point at which the
sound disappears. This is the diastolic pressure.
f. Step 6. Deflate the cuff completely.
1) Record the blood pressure as systolic/diastolic pressure.
8. Blood pressure by palpation
a. Step 1. Expose the patient's upper arm.
1) Select the correct size of blood pressure cuff for the patient.
2) Wrap the pressure cuff evenly around the patient's upper arm at
least one inch above the elbow.
3) Place the arrow on the cuff over the patient's brachial artery.
b. Step 2. Locate the patient's radial artery.
1) Rapidly inflate the cuff until you can no longer feel the radial
pulse.
2) Inflate the cuff 30 mm Hg beyond the point at which you last
felt the pulse.
c. Step 3. While watching the gauge, deflate the cuff slowly and
evenly at a rate of 2 to 3 mm Hg per second.
1) Note the point on the gauge when you feel the return of the
radial pulse. This is the systolic pressure and should be near
the point where the radial pulse disappeared.
d. Step 4. Deflate the cuff completely. Record the blood pressure as
systolic/P (for example, 148/P).
 When a blood pressure is obtained by palpation, the diastolic pressure cannot be
measured. Document the patient’s blood pressure as the systolic pressure over a capital “P,”
such as 110/P.
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 17
Slide #
46
Instructor Notes
9. Normal blood pressure at rest
Life Stage
Newborn
Infant
Toddler
Preschooler
School-age child
Adolescent
Adult
47
48
49
Age
Birth to 1 month
1 to 12 months
1 to 3 years
4 to 5 years
6 to 12 years
13 to 18 years
18 years and older
Systolic Pressure
74 to 100
84 to 106
98 to 106
98 to 112
104 to 124
118 to 132
100 to 119
Diastolic Pressure
50 to 68
56 to 70
50 to 70
64 to 70
64 to 80
70 to 82
60 to 79
10. Unstable patient
a. Assess and record vital signs every 5 minutes
11. Stable patient
a. Assess and record vital signs (at a minimum) every 15 minutes
12. Remember: A stable patient can become unstable very quickly.
Reassess frequently!
K. Additional Vital Signs
1. Pulse oximetry
a. Pulse oximetry is a method of measuring the amount of oxygen
saturated in the blood.
1) Commonly referred to as pulse ox
b. An oximeter is a small machine used to obtain this measurement.
c. A small sensor is placed on an area of the patient’s body in which a
pulsation can be detected, such as a fingertip or ear lobe.
d. The sensor is connected to the oximeter, which is a small
computer. The sensor passes red and infrared light waves through
the tissue to which it is attached.
e. Most of the body’s oxygen is attached to hemoglobin molecules in
the arterial blood.
1) Hemoglobin absorbs red and infrared light waves differently
when it is bound with oxygen than when it is not.
2) The oximeter calculates the amount of hemoglobin saturated
with oxygen. This calculation is called the saturation of
peripheral oxygen or SpO2.
3) The oximeter displays this value as a percentage on its screen
as well as the patient’s pulse rate.
 Pulse oximetry is used to detect and provide warnings about low levels of oxygen in the
blood. A reading between 96 percent and 100 percent generally indicates adequate
oxygenation. A reading between 91 percent and 95 percent suggests a mild lack of oxygen
in the tissues (hypoxia). A reading below 91 percent generally indicates severe hypoxia.
Supplemental oxygen is usually given to patients whose readings are below 91 percent.
Copyright 2008, McGraw-Hill
18 Emergency Medical Technician Instructor’s Lesson Plans
Slide #
50
51
Instructor Notes
To use a pulse oximeter:
1) Make sure there is no dirt or obstruction on the oximeter’s red
light.
a) If dirt is present, remove it and clean the device before
putting it on the patient.
b) Clean the tissue on the patient to which the oximeter will
be attached, such as the fingertip or earlobe.
c) If the patient’s fingertip is used, remove any dark or
metallic nail polish, if present.
2) Attach the pulse oximeter to the patient.
a) If the fingertip is used, insert the patient’s finger into the
oximeter. Make sure the patient’s tissue is centered over
the light and detector.
b) Turn the pulse oximeter on.
c) To make sure the pulse oximeter’s measurements are
accurate, check the patient’s pulse to be sure that the pulse
rate shown on the oximeter is consistent with what you feel
(palpate) when assessing the patient.
g. Indications
1) Altered mental status
2) Respiratory rate outside the normal range for age
3) Increased work of breathing
4) Respiratory or cardiac chief complaints
5) History of respiratory difficulty or respiratory disease
6) During delivery of supplemental oxygen
7) During and after endotracheal intubation
8) During transport of a sick or injured child
f.
 A pulse oximeter measures oxygen saturation. It does not measure the effectiveness of
ventilation.
 Too often, EMS professionals use a pulse oximeter as their only source for determining
the patient’s heart rate and oxygen level. Although a pulse oximeter is a useful device, it is
not a replacement for patient assessment.
52
53
h. Pulse oximeter readings may be inaccurate in the following
circumstances:
1) Poor capillary blood flow
2) Abnormal hemoglobin concentration
3) Abnormal shape of the hemoglobin molecule
i. Examples of conditions that may cause these situations, resulting in
misleading pulse oximetry readings, include the following:
1) Cardiac arrest
2) Shock
3) Hypothermia
4) Carbon monoxide poisoning
5) Sickle-cell disease
6) Patient movement, shivering
7) Patient use of nail polish
2. End-tidal carbon dioxide (ETCO2)
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 19
Slide #
54
55
56
Instructor Notes
a. Some EMS agencies consider end-tidal carbon dioxide an
additional vital sign.
b. An end-tidal carbon dioxide detector measures a person’s exhaled
carbon dioxide.
c. Although an ETCO2 detector is most often used to confirm the
position of a tube that has been placed in a patient’s trachea, some
detectors can be used with oxygen delivery devices, such as a nasal
cannula or bag-mask device.
3. Pain assessment
a. Some regulatory agencies consider an assessment of a patient’s
pain an additional vital sign.
b. EMS and other healthcare professionals often underestimate a
patient’s pain. Some of the reasons for this may include the
following:
1) Some healthcare professionals believe it is a “waste of time” to
ask a patient about her pain.
2) Because pain is unique to the person experiencing it, it is
difficult for another person to accurately tell how severe the
pain is.
3) The patient may be unable to relay her needs about the pain.
c. To assess pain in an adult, ask: “On a scale of 0 to 10, with 0 being
the least and 10 being the worst, what number would you give your
pain or discomfort?”
d. To assess pain in a child three years or older, use the Wong-Baker
FACES Pain Rating Scale.
1) This scale shows 6 cartoon faces ranging from a smiling face
representing “no hurt” to a tearful, sad face representing “worst
hurt.”
2) To use the scale, explain to the child that each picture is a
person’s face.
a) Face 0 is very happy because he doesn’t hurt at all.
b) Face 1 hurts just a little bit.
c) Face 2 hurts a little more.
d) Face 3 hurts even more.
e) Face 4 hurts a whole lot.
f) Face 5 hurts as much as you can imagine, although you
don't have to be crying to feel this bad.
3) Ask the child to point to the face that best describes how she is
feeling.
a) Document the number indicated by the child. For example,
“Patient rates pain 4 out of 10 on Faces Pain Scale.”
b) This is usually simplified when documenting on a
prehospital care report to, “Pain 4/10 on FACES Pain
Scale.”
 If the patient is able to express pain, the way in which it is expressed varies. A patient
may have tremendous pain, yet show no outward signs of her discomfort. On the other
hand, a patient may cry, be very loud and expressive, or revert to childhood behavior when
she is in pain.
Copyright 2008, McGraw-Hill
20 Emergency Medical Technician Instructor’s Lesson Plans
Slide #
57
58
Objective 23
59
Objective 26
60
Instructor Notes
L. SAMPLE History
1. SAMPLE History
a. The patient history is part of the patient assessment during which
you find out pertinent facts about the patient’s medical history.
b. When possible, ask the patient questions.
1) Try to avoid questions that the patient can answer with a yes or
no.
2) Instead, ask questions that will give you as much information
as possible, and then allow the patient time to answer.
3) Do not anticipate what the patient is going to say and finish
sentences for him.
c. In some situations, the patient will not be able to answer your
questions.
1) For example, the patient may be unresponsive or too short of
breath to provide detailed answers.
2) If the patient is unresponsive, gather as much information as
possible by looking at the scene, looking for medical
identification tags, and questioning family members,
coworkers, or others at the scene.
2. SAMPLE is a memory aid used to remind you of the information that
you should get from the patient.
a. SAMPLE stands for:
1) Signs and symptoms
2) Allergies
a) Find out if the patient has an allergy to medications, food,
environmental causes (such as pollen or bees), and
products (such as latex).
b) Check for a medical identification tag. The patient may be
wearing a bracelet or necklace or carrying a wallet card
that identifies a serious medical condition, allergies, or
medications she is taking.
3) Medications
a) Find out if the patient is currently taking any medications.
b) You will need to ask specific questions because some
patients do not consider some substances medications,
such as vitamins or aspirin.
4) (Pertinent) Past medical history
a) Ask the patient about medical conditions he may have that
may help you determine what the problem is today.
b) If the patient is unresponsive, check for a medic alert tag.
5) Last oral intake
a) It is important to determine when the patient last ate or had
anything to drink. This is especially important if the patient
is a diabetic or may need immediate surgery.
b) Determine what he last ate or drank, how much he ate or
drank, and when.
6) Events leading to the injury or illness
a) Ask the patient to tell you what happened.
b) This information can provide important clues about the
patient’s current situation.
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 21
Slide #
Instructor Notes
 With medical patients, take the patient’s history before performing the physical exam.
With trauma patients, perform the physical exam first.
 Ask your patient about the frequency with which his symptoms occur. Use this guide to
help pinpoint symptom frequency:
 Constant means 90 to 100 percent of the time.
 Frequent means about 75 percent of the time.
 Intermittent means about 50 percent of the time.
 Occasional means about 25 percent of the time.
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62
3. OPQRST
a. If your patient is complaining of pain, OPQRST is a memory aid
that may help identify the type and location of the patient’s
complaint.
b. Onset: “What were you doing when the problem started?”
c. Provocation/Palliation: “What makes the problem better or
worse?”
d. Quality: “What does the pain feel like (dull, burning, sharp,
stabbing, shooting, throbbing, pressure, or tearing)?”
e. Region/Radiation: “Where is the pain?” “Is the pain in one area, or
does it move?” “Is the pain located in any other area?”
f. Severity: “On a scale of 0 to 10, with 0 being the least and 10 being
the worst, what number would you assign your pain or
discomfort?”
g. Time: “How long ago did the problem or discomfort begin?”
“Have you ever had this pain before?” “When?” “How long did it
last?”
M. Questions?
Copyright 2008, McGraw-Hill
22 Emergency Medical Technician Instructor’s Lesson Plans
VIII. Lesson Enhancements
The materials on the following pages are provided to enhance the information presented in
this lesson.

Chapter Quiz. This quiz was created for you to copy and give to your students. These
questions are also available in a computerized test bank on the McGraw-Hill OLC. None of
these questions appears in the student textbook.
o Chapter Quiz Answers

Activities
o Activity 1. Gather blood pressure cuffs, stethoscopes, and penlights for your
students. Ask each student to take one set of vital signs on one-half of the class and
record his or her findings. Make it a point to have the students practice these skills
often throughout the course.
o Activity 2. Case Study. Ask your students to read the case study. Then ask them
how they would continue patient care or respond to the questions provided.
o Activity 3. Crossword Puzzle

Skill Sheets
o Skill #2—Blood Pressure by Auscultation
o Skill #3—Blood Pressure by Palpation
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 23
Chapter 5 Quiz—Baseline Vital Signs and SAMPLE History
Name __________________________________
Date __________________
Multiple Choice
In the space provided, identify the letter of the choice that best completes the statement or
answers each question.
____ 1.
Which of the following is a possible cause of a slow heart rate?
A. Fever
B. Pain or anxiety
C. Very low body temperature
D. Substances such as caffeine and nicotine
____ 2.
A pulse that is weak and fast is described as
A. normal.
B. sturdy.
C. thready.
D. bounding.
____ 3.
When obtaining a patient's blood pressure, the pressure cuff should be wrapped
evenly
A. around the patient's forearm, about two inches below the elbow.
B. around the patient's upper arm, at least one inch above the elbow.
C. around the patient's upper arm, at least two inches above the elbow.
D. around the patient's forearm at least twice to ensure an accurate reading.
____ 4.
Which of the following is a harsh, high-pitched sound associated with severe
upper airway obstruction?
A. Stridor
B. Gurgling
C. Cyanosis
D. Wheezing
____ 5.
Which of the following pulse points is generally assessed first in a responsive
adult?
A. Radial artery
B. Carotid artery
C. Brachial artery
D. Femoral artery
Copyright 2008, McGraw-Hill
24 Emergency Medical Technician Instructor’s Lesson Plans
____ 6.
Which of the following questions should be asked to determine the quality of a
patient's pain or discomfort?
A. “Where is the pain?”
B. “What does the pain feel like?"
C. “What makes the problem better or worse?”
D. "How long has your discomfort been present?”
____ 7.
The diaphragm of a stethoscope
A. has a deep, hollow, cuplike shape.
B. is the circular, flat part at the end of the tubing.
C. should be placed on the patient’s clothing to amplify sounds.
D. is the metal piece that connect the earpieces to the plastic or rubber tubing.
____ 8.
A newborn's normal heart rate at rest is about
A. 60 to 100 beats per minute.
B. 100 to 140 beats per minute.
C. 120 to 160 beats per minute.
D. 160 to 200 beats per minute.
____ 9.
Which of the following peripheral pulses is located just behind the ankle bone?
A. Radial artery
B. Brachial artery
C. Dorsalis pedis artery
D. Posterior tibial artery
____ 10.
The presence of cyanosis suggests
A. heat exposure.
B. adequate perfusion.
C. inadequate oxygenation.
D. liver or gallbladder disease.
Sentence Completion
In the blanks provided, write the words that best complete each sentence.
11.
The sound heard as air passes through moist secretions in the airway is called
_______________________.
12.
_______________________ is an irregular or patchy skin discoloration that is usually a
mixture of blue and white.
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 25
Short Answer
Answer each question in the space provided.
13.
List three possible causes of unequal pupils.
1.
2.
3.
14.
age.
List three possible causes of a respiratory rate that is faster than normal for the patient's
1.
2.
3.
15.
List three attributes that should be assessed when evaluating a patient's pulse.
1.
2.
3.
16.
Describe the patient's pupils in each of the drawings below using the following labels:
constricted pupils, dilated pupils, equal pupils, and unequal pupils.
[McGraw-Hill to Insert Figure 5-8 without labels.]
Copyright 2008, McGraw-Hill
26 Emergency Medical Technician Instructor’s Lesson Plans
Chapter 5 Quiz Answers—Baseline Vital Signs and SAMPLE History
Multiple Choice
1.
ANS:
C
Possible causes of a slow heart rate include the following: coughing, vomiting, straining to have
a bowel movement, heart attack, head injury, very low body temperature (hypothermia), sleep
apnea, and some medications. The other answers listed are more likely to increase heart rate.
OBJ: Identify the information obtained when assessing a patient's pulse.
2.
ANS:
C
A normal pulse is easily felt and obliterated by strong pressure, and the pressure is equal for each
beat. This kind of pulse is said to be a “strong” pulse. A pulse is said to be “weak” if it is hard to
feel. A pulse that is weak and fast is called a “thready” pulse. An extremely strong pulse that is
difficult to obliterate with pressure is called a "bounding" pulse.
OBJ: Differentiate between a strong, weak, regular, and irregular pulse.
3.
ANS:
B
After selecting the correct size of blood pressure cuff for the patient, wrap the pressure cuff
evenly around the patient's upper arm at least one inch above the elbow.
OBJ: Describe the methods to assess blood pressure.
4.
ANS:
A
Stridor is a harsh, high-pitched sound (like the bark of a seal). It is associated with severe upper
airway obstruction and is most often heard during inhalation. Wheezing is a high-pitched
whistling sound heard on inhalation or exhalation that suggests a narrowed or partially
obstructed airway. Gurgling is the sound heard as air passes through moist secretions in the
airway. Cyanosis is a bluish color of the skin that suggests inadequate breathing or poor
perfusion.
OBJ: Differentiate between shallow, labored and noisy breathing.
5.
ANS:
A
The radial pulse is located in the wrist at the base of the thumb. Check for a radial pulse first
when assessing a responsive adult or a child 1 year of age or older.
OBJ: Describe the methods to obtain a pulse rate.
6.
ANS:
B
When determining the quality of a patient's pain or discomfort ask, “What does the pain feel like
(dull, burning, sharp, stabbing, shooting, throbbing, pressure, or tearing)?”
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 27
OBJ: Identify the components of the SAMPLE history.
7.
ANS:
B
The diaphragm is the circular, flat part at the end of the tubing. It has a thin plastic disk on the
end. The diaphragm is used to detect high-pitched sounds, such as breath sounds. The binaurals
are the metal pieces of the stethoscope that connect the earpieces to the plastic or rubber tubing.
Some stethoscopes are equipped with a bell. The bell has a deep, hollow, cuplike shape. It is
used to detect low-pitched sounds such as those heard during blood pressure measurement. When
possible, the stethoscope should be placed directly on the patient’s skin because clothing makes
sounds harder to hear.
OBJ: N/A
8.
ANS:
C
A newborn's normal heart rate at rest is 120 to 160 beats per minute.
OBJ: Describe the methods to obtain a pulse rate.
9.
ANS:
D
The posterior tibial artery is located just behind the ankle bone. It is used to assess circulation in
the lower extremities.
OBJ: Describe the methods to obtain a pulse rate.
10. ANS:
C
Cyanosis is a blue-gray color of the skin or mucous membranes that suggests inadequate
oxygenation or poor perfusion.
OBJ: Differentiate between pale, blue, red and yellow skin color.
Sentence Completion
11. ANS:
called gurgling.
The sound heard as air passes through moist secretions in the airway is
OBJ: Differentiate between shallow, labored and noisy breathing.
12. ANS:
Mottling is an irregular or patchy skin discoloration that is usually a mixture
of blue and white.
OBJ: Identify the normal and abnormal skin colors.
Copyright 2008, McGraw-Hill
28 Emergency Medical Technician Instructor’s Lesson Plans
Short Answer
13. ANS:
Unequal pupils, a condition called aniscoria, are a normal finding in 2 to 4
percent of the population. In most patients, unequal pupils suggest a head injury, a stroke, the
presence of an artificial eye, or cataract surgery on one eye.
OBJ: Differentiate between reactive and nonreactive pupils and equal and unequal pupils.
14. ANS:
The number of respirations per minute can be influenced by many factors.
For example, exercise, stress, anxiety, pain, fever, and the use of stimulants can increase the
respiratory rate. The use of narcotics or sedatives decreases the respiratory rate.
OBJ: Describe the methods to obtain a breathing rate.
15.
ANS:
Assess a patient's pulse rate, regularity, and quality (strength).
OBJ: Identify the information obtained when assessing a patient's pulse.
16. ANS:
[McGraw-Hill to Insert Figure 5-8 with labels.]
OBJ: Differentiate between dilated (big) and constricted (small) pupil size.
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 29
Activity 2. Case Study—Baseline Vital Signs and SAMPLE History
You and your partner are called for an “ill man.” You arrive to find an unresponsive man sitting
in the driver’s seat of a vehicle that is parked in a shopping center. The patient appears to be
about 35 years old. Upon examination, you do not note any unusual breath odors. There are no
signs of trauma. No medical identification tag or card is found. You have obtained the following
vital signs:
Time
10:30
10:45
Pulse
80 strong, regular
82 strong, regular
BP
118/80
120/86
Respirations
18
18
Pupils
PEARL
PEARL
Skin
Pink, warm, dry
Pink, warm, dry
1. Can you provide emergency care to this patient if he is unable to consent to
treatment?
2. Are the patient’s vital signs within normal limits?
3. Based on the patient’s condition, were the patient’s vital signs obtained at appropriate
intervals?
4. What are some of the possible causes of this patient’s condition?
Copyright 2008, McGraw-Hill
30 Emergency Medical Technician Instructor’s Lesson Plans
Activity 2. Case Study, Possible Answers
1. Can you provide emergency care to this patient if he is unable to consent to treatment?
Yes. The patient’s consent to treatment is implied if he is unresponsive.
2. Are the patient’s vital signs within normal limits?
Yes, the patient’s vital signs are within normal limits for his age.
3. Based on the patient’s condition, were the patient’s vital signs obtained at appropriate
intervals?
No. An unresponsive patient is an unstable patient. An unstable patient requires vital signs
taken at least every 5 minutes. This patient’s vital signs were taken 15 minutes apart.
4. What are some of the possible causes of this patient’s condition?
Possible causes include a diabetic emergency, stroke, heart attack, or overdose, among many
others (see Chapter 18).
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 31
Activity 3. Crossword—Baseline Vital Signs and SAMPLE History
Name __________________________________
Date __________________
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Across
2. "M" in SAMPLE history
5. Abbreviation for blood pressure
10. The pressure in an artery when the heart is at rest
12. Capillary refill is normally less than ____ seconds.
14. The part of a patient assessment that provides pertinent facts about the patient’s current medical
problem and previous conditions
15. "O" in OPQRST
16. A condition described by the patient
17. Assessment tool used in infants and children (2 words)
Copyright 2008, McGraw-Hill
32 Emergency Medical Technician Instructor’s Lesson Plans
Down
1. Because signs can be seen, heard, smelled, measured, or felt, they are considered _____ findings.
3. The process of breathing out and moving air out of the lungs
4. An example of a symptom
6. "P" in OPQRST
7. An example of a central pulse
8. Blood pressure is measured in ____ of mercury (Hg).
9. Assessments of breathing, pulse, temperature, pupils, and blood pressure (2 words)
10. The circular, flat part at the end of stethoscope tubing
11. An instrument used to hear sounds within the body
13. A ____ pulse is found close to the trunk of the body.
Copyright 2008, McGraw-Hill
Chapter 5 – Baseline Vital Signs and SAMPLE History 33
Activity 3. Crossword Solution—Baseline Vital Signs and SAMPLE
History
1
2
6
3
M E
P
D
I
C
A
T
I
O
X
R
S
9
L
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Copyright 2008, McGraw-Hill
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34 Emergency Medical Technician Instructor’s Lesson Plans
Skill #2
BLOOD PRESSURE BY AUSCULTATION
Student:
Evaluator
Date
Activity
Puts on appropriate personal protective equipment
Identifies and assembles appropriate equipment and supplies
Exposes the patient's upper arm
Selects the correct size of blood pressure cuff for the patient
Wraps the pressure cuff evenly around the patient's upper arm at least one inch
above the elbow
Places the arrow on the cuff over the patient's brachial artery
Locates the patient's radial artery
Rapidly inflates the cuff until the patient’s radial pulse is no longer felt
Inflates the cuff 30 mm Hg beyond the point at which the pulse was last felt
Places the diaphragm of the stethoscope over the patient’s brachial artery and
holds it in place
Places the earpieces of the stethoscope in his or her ears
While watching the gauge, deflates the cuff slowly and evenly at a rate of 2 to 3
mm Hg per second
Listens for sounds
Recognizes that the first sound is the systolic pressure
Continues to deflate the cuff, noting the point where the sound disappears
Recognizes that this is the diastolic pressure
Completely deflates the cuff
Correctly documents the blood pressure as systolic/diastolic pressure
Unacceptable Actions

Failed to select the correct size of blood pressure cuff

Failed to accurately determine blood pressure

Did not follow the skill sequence
Comments:
Copyright 2008, McGraw-Hill
Satisfactory
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Unacceptable
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Chapter 5 – Baseline Vital Signs and SAMPLE History 35
Skill #3
BLOOD PRESSURE BY PALPATION
Student:
Evaluator
Date
Activity
Puts on appropriate personal protective equipment
Identifies and assembles appropriate equipment and supplies
Exposes the patient's upper arm
Selects the correct size of blood pressure cuff for the patient
Wraps the pressure cuff evenly around the patient's upper arm at least one inch
above the elbow
Places the arrow on the cuff over the patient's brachial artery
Locates the patient's radial artery
Rapidly inflates the cuff until the patient’s radial pulse is no longer felt
Inflates the cuff 30 mm Hg beyond the point at which the pulse was last felt
Places the diaphragm of the stethoscope over the patient’s brachial artery and
holds it in place
Places the earpieces of the stethoscope in his or her ears
While watching the gauge, deflates the cuff slowly and evenly at a rate of 2 to 3
mm Hg per second
Listens for sounds
Recognizes that the first sound is the systolic pressure
Recognizes that the diastolic pressure cannot be accurately measured by
palpation
Completely deflates the cuff
Correctly documents the blood pressure as systolic/P (for example, 148/P)
Unacceptable Actions

Failed to select the correct size of blood pressure cuff

Failed to accurately determine blood pressure

Did not follow the skill sequence
Comments:
Copyright 2008, McGraw-Hill
Satisfactory

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Unacceptable
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36 Emergency Medical Technician Instructor’s Lesson Plans
Chapter 5 Handout—Normal Vital Signs
Normal Pulse Rates at Rest
Life Stage
Newborn
Infant
Toddler
Preschooler
School-age
child
Adolescent
Adult
Age
Birth to 1 month
1 to 12 months
1 to 3 years
4 to 5 years
6 to 12 years
Beats per Minute
120 to 160
80 to 140
80 to 130
80 to 120
70 to 110
13 to 18 years
18 years and older
60 to 100
60 to 100
Normal Respiratory Rates at Rest
Life Stage
Newborn
Infant
Toddler
Preschooler
School-age
child
Adolescent
Adult
Age
Birth to 1 month
1 to 12 months
1 to 3 years
4 to 5 years
6 to 12 years
Breaths per Minute
30 to 50
20 to 40
20 to 30
20 to 30
16 to 30
13 to 18 years
18 years and older
12 to 20
12 to 20
Normal Blood Pressure at Rest
Life Stage
Newborn
Infant
Toddler
Preschooler
School-age
child
Adolescent
Adult
Age
Birth to 1 month
1 to 12 months
1 to 3 years
4 to 5 years
6 to 12 years
13 to 18 years
18 years and older
Systolic Pressure
74 to 100
84 to 106
98 to 106
98 to 112
104 to 124
Diastolic Pressure
50 to 68
56 to 70
50 to 70
64 to 70
64 to 80
118 to 132
100 to 119
70 to 82
60 to 79
Copyright 2008, McGraw-Hill