Download Vital Signs, Lung and Heart Examination

Vital Signs, Lung and Heart
Examination
Matthew L. Picone MD, MSEd
St. Joseph’s Hospital
Vital Signs
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Heart Rate or Pulse
Respiratory Rate
Temperature
Blood Pressure
Oxygen Saturation-O2 sat
Vital Signs
• Areas of important interest to take the
Pulse Rate: Neck-Carotids, Wrist:Radial,
Groin-Femoral, Ankle-Posterior Tibialis
• All of these VS are influenced upon each
other and react to the change-normally.
Example: When your temperature goes up
it’s a normal physiologic response to have
your RR and HR go up as well.
Vital Sign Changes
• When BP goes down it is normal for the
HR go up to in an attempt to compensate.
• Sleep State: All go down to low normal or
even abnormal during Deep Sleep StateStage 4
• Exception-REM state or Dream statewhere almost anything can happen with
VS
Heart Rate or Pulse
• Normal Ranges
• Abnormal Ranges
• Abnormal findings that can be normal and
non-concerning
Children’s Normal HR
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Age
Birth
6 mo
1 yr
2 yr
6 yr
8 yr
10 yr
Heart Rate
140
130
115
110
103
100
95
Adult Heart Rates
• By Definition: 60-100 beats/min
• Below 60 can be normal for many athletesrunners especially can have HR 40-60.
• Some adults have normal HR over 100, usually
100-110.
• If an individual is anxious, just finishing
skiing(exercising) or on certain medications
then HR can vary out of the normal range either
high or low.
Abnormal HR
• HR >> 125-150b/min
• Assess for regularity of rhythm
• Patients will sometimes feel nothing,
palpitations. Assess for lightheaded,
dizziness and syncope.
• Maneuvers that can slow the HR down
• Oxygen is always helpful in this setting
Fight or Flight Response
When our fight or flight response is activated, sequences of
nerve cell firing occur and chemicals like adrenaline,
noradrenaline and cortisol are released into our bloodstream.
These patterns of nerve cell firing and chemical release cause
our body to undergo a series of very dramatic changes. Our
respiratory rate increases. Blood is shunted away from our
digestive tract and directed into our muscles and limbs, which
require extra energy and fuel for running and fighting. Our
pupils dilate. Our awareness intensifies. Our sight sharpens.
Our impulses quicken. Our perception of pain diminishes. Our
immune system mobilizes with increased activation. We
become prepared—physically and psychologically—for fight or
flight. We scan and search our environment, "looking for the
enemy."
Fight or Flight
Fight or Flight
Stethoscope Positioning
Stethoscope
Heart Sounds Positioning
Before You Begin
a) Try to create a quiet environment as much as possible. This may be
difficult in a busy emergency room or in a room with other patients and
their visitors. Eliminate noise by closing the door and turning off any radio
or televisions in the room.
b) The patient should be in the proper position for auscultation, i.e. sitting
up in bed leaning forward, lying on his/her left side, or supine or at 30
degree elevation on the examining table.
Positioning for Heart Sounds
c) Your stethoscope should be touching the patient's bare skin
whenever possible or you may hear rubbing of the patient's clothes
against the stethoscope and misinterpret them as abnormal sounds.
You may wish to wet the patient's chest hair with a little warm water
to decrease the sounds caused by friction of hair against the
stethoscope.
d) Always ensure patient comfort. Be considerate and warm the
diaphragm of your stethoscope with your hand before auscultation.
Audio Heart Sounds
http://www.easyauscultation.com/heartsounds.aspx
Listening to the heart in the Right and Left
Intercostal space in the Anterior
midclavicular line. Followed by left lateral
sternal border in the remaining spots
Normal pediatric respiratory rate
for infants, newborn, toddlers, and children
Groups of children
Their ages
Normal respiratory rates
Newborns and infants
Up to 6 months old
30-60 breaths/min
Infants
6 to 12 months old
24-30 breaths/min
Toddlers and children
1 to 5 years old
20-30 breaths/min
Children
6 to 12 years
12-20 breaths/min
Adult Respiratory Rates
• Normal: 12-18 breaths/min
• Abnormal called Tachypnea >20 br/min
• If RR > 24 br/min then look for signs of
distress.
• Check O2 Saturation-pulse oxygenation
• Normal O2 saturation: > 92-100%
Abnormally fast RR
• Hyperventilation Syndrome: or rapid RR
• Mental Health Causes: Anxiety or Panic
• Medical Causes: Diabetes out of
control(DKA)
• Physiologic Causes: Taking too many
deep breaths and increasing rate.
Sometimes seen in laboring woman
Hyperventilation Syndrome
• Metabolic Results: Loss of CO2
• Physiologic results: Compensatory in
uncontrolled diabetes to blow-off CO2
• Physical Symptoms you may see:
• Numbness and tingling in face, hands or
feet.
• Chest Pains, dizzy, sweaty, confused and
sometimes fainting occurs
Auscultation of Lung Sounds
Respiration
• http://www.easyauscultation.com/heartsounds.aspx