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Emergency Medical Technician - Basic
Health Science Core
Chapter 10 and Patient Assessments
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Revised: August 2007
Chapter 10
Fundamental Skills
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Vital Signs
• Vital – means essential to life
• Sign – means objective
finding or evidence of an
illness
• Vital signs is essential
information of the body
– Temperature
– Respiration
– Blood pressure
– Oxygen saturation
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Revised: August 2007
Homeostasis
• A state of equilibrium within the
body maintained through
adaptation of body systems to
change in either the internal or
external environment
• Vital signs represent different
mechanisms in the process of
homeostasis
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Revised: August 2007
Temperature
• 80% of heat loss is through
the skin
• Hypothalamus – portion of
the brain that controls the
temperature of the body
– Blood vessels – dilate to
increase heat loss
– Sweat glands – impulse
to stimulate perspiration
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Oral Temperature
• Probe is placed under
the tongue and
patient should close
his/her lips
• Probe cover should
be used on every
patient
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Rectal Temperature
• Children under 5 years old
• Most accurate method to
read temperature
• Lubricate probe with KY Jelly
• Slide probe about ½ inch and
do not force
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Revised: August 2007
Tympanic Temperature
• Reading temperature on the
ear drum which provides
blood supply temperature to
hypothalamus
• Point probe toward the ear
canal
• Be careful to not insert the
probe too far and cause
damage to tympanic
membrane
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Revised: August 2007
Axillary Temperature
• Taken in the armpit
• Least accurate
method
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Revised: August 2007
Temperature Comparison
Two temperature scales
• Fahrenheit
– Normal 98.6
– Convert to Celsius
.555 (98.6-32) = C
• Celsius
– Normal 37
– Convert to
Fahrenheit
(37x1.8) + 32 = F
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Device Temperature Difference
Revised: August 2007
Pulse
• Beats Per Minute – Count the
number of heartbeat using the
fingers to palpate an artery over
15 seconds and multiply by 4.
• Normal range:
– Adult
60-100 BPM
– Child over 7 y/o 72-90 BPM
– Child 1-7 y/o 80-120 BPM
– Infants
90-140 BPM
• Average male pumps 5 liters of
blood a minute
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Pulse Locations
•
•
•
•
•
•
Radial
Carotid
Brachial
Femoral
Dorsalis Pedis
Posterior Tibial
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Pulse Findings
• Regular – evenly timed beats
• Irregular – unevenly timed
beats
• Weak or thready – barely feel
• Bounding or strong – feel
easier than normal
• Tachycardia – above 100
BPM
• Bradycardia – below 60 BPM
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Respiration
• The rate of breathing
• Gas exchange process
– Expiration – elimination
of carbon dioxide by
relaxation of the
diaphragm and muscle
– Inspiration – inhale of air
to receive oxygen by
contracting diaphragm
and intercostal muscle
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Respiration Rates
Breaths Per Minute - Count number
of respirations over 15 seconds and
multiply by 4
•
•
•
•
•
15 years and older
5 to 15 years
2 to 5 years
4 weeks to 1 year
Newborn
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15-20 BPM
20-25 BPM
20-30 BPM
20-40 BPM
30-50 BPM
Revised: August 2007
Respiration Findings
•
•
•
•
Apnea – no breathing
Bradypnea – abnormally slow breathing
Tachypnea – abnormally fast breathing
Cheyne-stokes respiration – irregular breathing pattern
with periods of apnea and gradual increase
• Kussmaul’s breathing – deep and
gasping respirations
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Revised: August 2007
Respiration Findings
• Labored breathing – difficulty breathing
that uses muscles in the shoulder, neck
and abdominal areas.
• Abnormal sounds:
– Stridor – upper airway obstruction
– Rales – crackling from fluid in the
lungs
– Wheezing – from narrowing airways
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Lung Sound Locations
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Blood Pressure
• Pressure of the blood exerted
against the arteries
• Systolic – heart contraction and
blood pressure rises as blood
moves along the vessel
• Diastolic – heart relaxes and blood
pressure falls as blood fills the
heart
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Blood Pressure
• Sphygmamanometer – blood
pressure cuff
– Need to be right size
– Roll up sleeve
– Line up brachial artery and
cuff indicator
– Place gauge in visible area
• Stethoscope
– Place diaphragm over
brachial artery
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Factors Affecting Blood Pressure
•
•
•
•
Proper size of cuff
Movement
Excessive noise
Emotional state of
patient
• Disease process
• Trauma
• Properly working
equipment
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Factors that Affect Blood Pressure Numbers
•
•
•
•
•
Emotions
Medications
Diet and weight
Stress
Patient’s position
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Blood Pressure Findings
• Hypertension – high blood
pressure
• Hypotension – low blood
pressure
– Difficulty auscultating
blood pressure and may
have to palpate blood
pressure
– Palpation only reads
systolic pressure
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Revised: August 2007
Weight
• Pediatrics – Use
Braselow tape or
measuring tape to
determine weight
• Adults – best guess
• Need to convert
pounds to kilograms
– Pounds divided by
2.2 = kilograms
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Revised: August 2007
Oximetry
• Oxygen - Reads the
level of oxygen that is
bound to the
hemoglobin
• Carbon Monoxide –
reads the level of
carbon monoxide that is
bound to the
hemoglobin
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Skin Perfusion
•
•
•
•
•
•
•
Hot
Warm
Cool
Cold
Dry
Moist
Capillary refill - Depress patient’s
finger nail for blood return
– Normal < 2 seconds
– Abnormal > 2 seconds
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Pupils
•
•
•
•
•
•
•
•
Maneuver pen light from
the lateral side of the eye
and shine over the pupil.
Fixed
Reactive
Sluggish
Equal
Unequal
Dilated
Constricted
Normal
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Patient Assessment
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Revised: August 2007
Assessment Steps
1. Scene Size-up
Assessment
2. Initial Assessment
3. Focus History
Assessment
4. Rapid / Primary Physical
Assessment
5. Detailed / Secondary
Physical Assessment
6. On-Going Assessment
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Revised: August 2007
Scene Size-up Assessment
•
Take body substance
isolation precautions.
– Gloves.
– Eye protection.
– Mask.
– Gowns.
– Trauma sleeves.
• Inspect the scene for safety
(personal protection).
McFatter Technical Center
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Scene Size-up Assessment
• Determines the
mechanism of injury or
nature of illness.
• Determines the number
of patients.
• Determines the need for
additional resources.
• Determines the need for
spinal immobilization.
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Initial Assessment
•
•
•
Inspect general impression of
the patient (visual
assessment).
– Overall appearance.
– Level of distress.
– Patient characteristics.
Student one introduces
himself / herself to the patient
and obtains consent for
patient care.
Determine chief complaint.
McFatter Technical Center
Revised: August 2007
Initial Assessment
• Determine mental status.
– AVPU scale – Alert, Verbal,
Pain, and Unresponsive.
– Orientation - Alert to person,
place, time, and event.
• Assess airway.
– Suspecting spinal injury Student two kneels behind the
head of the patient and applies
manual immobilization of head
in a neutral in-line position for
trauma.
• Assess breathing.
McFatter Technical Center
Revised: August 2007
Initial Assessment
• Assess circulation.
• Assess and control major external
bleeding.
• Assess perfusion.
– Color.
– Temperature.
– Condition.
– Capillary refill.
• Identify priority and transport
decisions.
McFatter Technical Center
Revised: August 2007
Focus History Assessment
•
Baseline vital signs.
– Pulse.
– Respirations.
– Blood Pressure.
– Oxygen saturation.
– Skin perfusion.
– Pupils.
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Revised: August 2007
Focus History Assessment
• SAMPLE History.
– Signs and symptoms –
includes OPQRST for
certain incidents.
– Allergies.
– Medications.
– Pertinent past history.
– Last oral intake.
– Events leading to the injury
or illness.
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Revised: August 2007
Rapid / Primary Physical Assessment
•
Inspect for DCAP BTLS:
– Deformities
– Contusions
– Abrasions
– Punctures/penetrations
– Burns
– Tenderness
– Lacerations
– Swelling
McFatter Technical Center
Revised: August 2007
Rapid / Primary Physical Assessment
• Palpate the head and neck.
– Inspect for jugular vein distention.
– Inspect for tracheal deviation.
– Palpate for crepitus.
– Suspected spinal injury - size and apply the
appropriate cervical collar
• Palpate the chest.
– Auscultate breath sounds on both sides of the chest.
– Inspect for symmetrical chest rise and fall.
– Inspect for paradoxical motion.
– Palpate for crepitus.
McFatter Technical Center
Revised: August 2007
Rapid / Primary Physical Assessment
• Palpate the abdomen in four
quadrants.
– Palpate for rigidity.
– Inspect for distension.
• Palpate the pelvis.
– Compress downward and
inward to identify any
instability.
McFatter Technical Center
Revised: August 2007
Rapid / Primary Physical Assessment
• Palpate all four extremities.
– Palpate distal pulses at the
dorsalis pedis or posterior
tibial, and radial.
– Inspect for motor function
with wiggling toes and
fingers.
– Inspect for sensory
function with squeezing or
pinching extremities.
• Assess the back.
McFatter Technical Center
Revised: August 2007
Detailed / Secondary Physical Assessment
Inspect for DCAP BTLS:
• Deformities
• Contusions
• Abrasions
• Punctures/penetratio
ns
• Burns
• Tenderness
• Lacerations
• Swelling
McFatter Technical Center
Revised: August 2007
Detailed / Secondary Physical Assessment
• Assess the head.
• Inspect around the eyes and eyelids for
redness.
– Inspect the eyes for contacts.
– Inspect the eyes for pupil function.
Take pen light from the corner of the
eye and shine on to the pupil.
Determine if the pupils are equal and
reactive.
• Inspect behind the ears for Battle’s Signs
(bruising).
– Inspect the ear canal for drainage of
blood or spinal fluid. Use 4x4 gauze
folded in fours to identify spinal fluid
inside blood by a halo.
McFatter Technical Center
Revised: August 2007
Detailed / Secondary Physical Assessment
• Palpate scalp for depressions of the skull.
• Palpate areas of the face like zygomas, maxillae, and
mandible for instability.
• Inspect the mouth for cyanosis around the lips, foreign
body (includes dentures or loose teeth), and unusual
odors.
• Inspect the nose.
• Palpate the front and back of the neck.
– Inspect for jugular vein distention.
– Inspect for tracheal deviation.
– Inspect skin for crepitus (crackling) under the skin.
McFatter Technical Center
Revised: August 2007
Detailed / Secondary Physical Assessment
• Palpate the chest over the ribs.
– Inspect for symmetrical chest rise
and fall.
– Inspect for paradoxical motion.
– Auscultate anterior breath sounds at
midaxillary and midclavicular area.
– Auscultate posterior breath sounds at
the bases and apices area.
– Palpate for crepitus.
McFatter Technical Center
Revised: August 2007
Detailed / Secondary Physical Assessment
• Palpate the abdomen in
four quadrants.
• Palpate for rigidity.
• Inspect for distension.
• Palpate the pelvis.
• Compress downward
and inward on the iliac
crest to identify any
instability.
McFatter Technical Center
Revised: August 2007
Detailed / Secondary Physical Assessment
• Palpate all four extremities.
– Inspect for medical alert
bracelets.
– Palpate dorsalis pedis or posterior
tibial pulse, and radial pulse.
– Inspect for motor function with
wiggling toes and fingers.
– Inspect for sensory function with
squeezing or pinching extremities.
• Palpate the back.
McFatter Technical Center
Revised: August 2007
On-Going Assessment
•
•
•
•
Repeat initial
assessment.
Reassess vital signs.
Repeat focused
assessment.
Check interventions.
McFatter Technical Center
Revised: August 2007
References
•
•
Pollak, Andrew N. Emergency Care and
Transportation of the Sick and Injured. 9th ed.
Sudbury, Massachusetts: Jones and Bartlett,
2005.
Stevens, Kay, and Garber, Debra. Introduction
to Clinical Allied Healthcare. 2nd ed. Clifton
Park, New York: Thomson Delmar Learning,
1996.
McFatter Technical Center
Revised: August 2007