Download December 2011 Instructor`s Guide (MS Word format)

Baseline Vitals and Sample History Company Drill
Instructor Guide
Session Reference: 1
Topic: Baseline Vitals and Sample History Company Drill
Level of Instruction: 2
Time Required: Three Hours
Materials
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Blood Pressure cuff & stethoscope
Pen light
Clock or wrist watch with second hand
Writing paper
Writing pencil
Personal protective equipment: gloves
References
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Brady Emergency Care, 11th Edition,
The Maryland Medical Protocols for Emergency Medical
Services Providers, Effective July 1, 2011, Maryland
Institute for Emergency Medical Services Systems
Preparation
Motivation
The Baseline Vitals and SAMPLE History are part of the
essential information necessary to obtain and document in
order to give a patient the best possible care in the field. This
information can alert the provider to call for additional
resources if necessary and can give those accepting care of the
patient at the next level of patient care a good idea of what
may be going on inside the patient’s body.
Objective (SPO) 1-1:
Given a live victim; blood pressure cuff; stethoscope; pencil;
paper; pen light; clock or wrist watch, the student will be able
to demonstrate, from memory and without assistance, the
proper procedures in obtaining a set of Baseline Vitals, to
include: pulse, respirations, skin color, skin temperature and
condition, pupil appearance, blood pressure and be able to
document the same at a practical station, as governed by The
Maryland Medical Protocols for Emergency Medical Services
Providers, Effective January 1, 2002 and the Brady Emergency
Care, 7th Edition, EMT-Basic National Standard Curriculum.
The student will also be able to score a 70% or above on a
written exam.
Objective (SPO) 2-1:
Given a live victim, pen and paper, the student will be able to
demonstrate, from memory and without assistance, the proper
procedure in obtaining a SAMPLE History, to include: signs
and symptoms, allergies, medications, past pertinent history,
last oral intake and events that lead to the problem, and be
able to document the same at a practical station as governed
by The Maryland Medical Protocols for Emergency Medical
Services Providers, Effective January 1, 2002 and the Brady
Emergency Care, 7th Edition, EMT-Basic National Standard
Curriculum. The student will also be able to score a 70% or
above on a written exam.
2
Overview:
Review of properly obtaining and documenting Baseline Vitals
and a SAMPLE History
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Pulse
Respirations
Skin color
Skin temperature and condition
Pupil appearance
Blood pressure
Signs and symptoms
Allergies
Medications
Past pertinent history
Last oral intake
Events that lead to problem
Session 1
Baseline Vitals
SPO 1-1
EO 1-1-1
EO 1-1-2
EO 1-1-3
EO 1-1-4
EO 1-1-5
EO 1-1-6
SPO 2-1
EO 2-1-1
Given a live victim; blood pressure cuff; stethoscope; pen
or pencil; paper; pen light; clock or wrist watch, the
student will be able to demonstrate, from memory and
without assistance, the proper procedures in obtaining
and documenting a set of Baseline Vitals.
Demonstrate the method of obtaining, assessing and
documenting a pulse rate.
Demonstrate the method of obtaining, assessing and
documenting a respiratory rate.
Demonstrate the method of obtaining and documenting
skin color.
Demonstrate the method of obtaining and documenting
skin temperature and condition.
Demonstrate the method of obtaining, assessing and
documenting pupil appearance.
Demonstrate the method of obtaining and documenting a
blood pressure by auscultation and palpation.
Given a live victim, pen and paper, the student will be
able to demonstrate, from memory and without
assistance, the proper procedure in obtaining and
documenting a SAMPLE History.
Demonstrate the method of obtaining and documenting a
SAMPLE History.
Instructional Guide
I.
Pulse (1-1-1)
A.
Pulse rate – number of heart beats per minute
1.
B.
C.
Factors that affect pulse rate
a.
Age
b.
Physical Condition
c.
Degree of exercise just completed
d.
Medical condition
e.
Medication
f.
Blood Loss
g.
Stress
h.
Body temperature
i.
Fear
Pulse types
1.
Tachycardia - rapid rate
2.
Bradycardia – slow rate
Pulse quality
1.
Rhythm
a.
Regularity
b.
intervals between beats constant
2.
Force - pressure of pulse wave as it expands artery
3.
Full pulse – strong wave
4.
Thready pulse – weak wave
D.
Pulse locations
1.
E.
F.
II.
Radial
a.
one year and above
c.
radial artery lateral side of forearm (thumb)
2.
Carotid – large artery on either side of neck
3.
Brachial – upper medial arm
4.
Dorsal Pedis - lateral to the large tendon of big toe
5.
Posterior tibial - behind medial ankle of foot
6.
Femoral - inside thigh of leg
Demonstrate how to obtain a pulse
1.
Finger placement
2.
Count by using second hand on watch or clock
a.
count for 30 seconds x 2
b.
count for15 seconds x 4
Demonstrate how to document a pulse
Respirations (1-1-2)
A.
Respiratory rate – number of breaths (in and out) per minute
1.
Normal rate
2.
Rapid rate
3.
Slow rate - all rates can be affected by
a.
age
b.
sex
B.
size
physical condition
e.
emotional state
f.
fear
Quality
1.
C.
c.
d.
Normal
a.
chest or abdomen moves average depth with each
breath
b.
not using accessory muscles
2.
Shallow - Slight movement of chest or abdomen
3.
Labored
a.
patient has to work hard to move air in and out
b.
use of accessory muscles
c.
nasal flaring
d.
retractions – pulling in above collarbones or
between ribs (especially in infants & children)
4.
Noisy - obstructed breathing
5.
Snoring - airway blocked
6.
Wheezing - medical problem such as Asthma
7.
Gurgling - fluids in the airway
8.
Crowing - noisy harsh sound when breathing in
Demonstrate how to obtain a respiratory rate
a.
Stethoscope
D.
II.
b.
Hand on chest
c.
Look with eyes
d.
Use of clock or wrist watch with second hand
Demonstrate how to document respiratory rate
Skin Color (1-1-3)
A.
Skin color
1.
Pink
2.
a.
Normal in light-skinned patients
b.
Normal at inner eyelids, lips, nail beds of darkskinned patients
Pale - Constricted blood vessels possible result of
a. Blood loss
3.
4.
b.
Shock
c.
Heart attack
e.
Emotional distress
Cyanotic (blue) - Lack of oxygen in blood cells and tissues
result of
a.
Inadequate breathing
b.
Inadequate heart function
Flushed (red)
a.
Exposure to heat
b.
High blood pressure
c.
Emotional excitement
B.
IV.
Jaundiced (yellow) - Liver abnormalities
6.
Mottling (blotchiness) - Occasionally in patients with
shock
Demonstrate how to document skin color
Skin Temperature & Condition (1-1-4)
1.
Cool and clammy
2.
Usual sign of shock
3.
Usual sign of anxiety
B.
Cold and moist - Body is losing heat
C.
Cold and dry - Exposure to cold
D.
Hot and dry
E.
F.
G.
V.
5.
1.
High fever
2.
Heat exposure
Hot and moist
1.
High fever
2.
Heat exposure
Goose pimples, shivering, chattering teeth, blue lips & pale skin
1.
Chills
2.
Communicable disease
3.
Exposure to cold, pain or fear
Demonstrate how to obtain skin temperature and condition
(Use gloved hand)
Pupil Appearance (1-1-5)
A.
Pupil is the black center of the eye - Amount of light that enters
the eye changes the size
B.
Evaluate pupils for
1.
Size
2.
Equality
a. Both equal in size
b.
3.
Causes of unequal pupils: stroke, head injury, eye
injury, artificial eye
Reactivity
a. Reacting to light by changing sizes
b. Causes for lack of reactivity: drugs, lack of
oxygen to the brain
C.
D.
VI.
Dilated Pupils
1.
Become larger
2.
Allow more light into the eye
3.
Causes for dilated pupils: fright, blood loss, drugs,
treatment with eye drops
Constricted Pupils
1.
Become smaller
2.
Large amount of light gets into the eye
E.
Demonstrate how to evaluate pupils - Use of pen light
F.
Demonstrate how to document pupil appearance
Blood Pressure (1-1-6)
A.
Blood Pressure – the force of blood against the walls of blood
vessels when Left ventricle (lower chamber) of heart contracts
and forces blood into circulation
B. Systolic – force of blood into the arteries when heart contracts
1.
Upper number read when taking a blood pressure
2.
First number given when reporting a blood pressure
3.
Systolic pressure usually parallels pulse rate
(When pulse rate increases, systolic does also)
Systolic reading is always an even number – if reading
falls between two lines use the higher reading
4.
C.
D.
E.
Diastolic – pressure remaining in the arteries when the left
ventricle of the heart relaxes and refills
1.
Lower number read when taking a blood pressure
2.
Second number given when reporting a blood pressure
3.
Diastolic reading is always an even number – if reading
falls between two lines use the higher number
High blood pressure causes
1.
Medical condition
2.
Exertion
4.
Fright
5.
Emotional distress or excitement
Low blood pressure causes
1.
Athlete or other person with normally low blood pressure
2.
Blood loss
3.
Late sign of shock
F.
Demonstrate obtaining a blood pressure
1.
2.
G.
VII.
Auscultation method
a.
Reading sphygmomanometer
b.
Placement of cuff
c.
Stethoscope placement
i.
Bell (also called Head or Chestpiece)
placement
ii.
Arm placement
Palpation method
a.
Cuff placement
b.
Hand placement
c.
Inflate cuff 30 mm of mercury above point where
you no longer feel a radial pulse
d.
Deflate cuff slowly
e.
Note reading at which the radial pulse returns
f.
This reading is the systolic reading
Demonstrate documenting a blood pressure
SAMPLE History (2-1-1)
A.
B.
Signs/Symptoms
1.
Why did you call 911
2.
What is wrong
3.
Document
Allergies
C.
1.
Medications
2.
Foods
3.
Environment
4.
Medical ID tag explaining allergies
5.
Document
Medications
1.
2.
3.
D.
Medications currently taking
a.
Prescribed
b.
Over the counter
c.
Recreational
If patient answers yes, ask:
a.
Name of medication
b.
Dosage and how often taken
c.
Why they are taking
d.
Was the medication taken today and when
e.
After taking was their any relief or change in
symptoms
Document
Pertinent past history
1.
Currently being treated for any illness
2.
Have you been feeling ill
3.
Any recent surgeries or injuries
E.
F.
Summary
4.
Have you been seeing a doctor
5.
What is your doctor’s name
6.
Document
Last oral intake
1.
When did you last eat or drink
2.
What did you eat or drink
3.
Document
Events leading to the injury or illness
1.
What were you doing before you began feeling this way
2.
Document
Review:
Properly obtaining and documenting Baseline Vitals and a
SAMPLE History
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Pulse: rate, type, quality
Respirations: rate, quality, method of obtaining
Skin Color: pink, pale, cyanotic, flushed, jaundiced,
mottling
Skin temperature and condition: cool/clammy,
cold/moist, cold/dry, hot/dry, hot/moist, goose pimples,
shivering, chattering teeth, blue lips, pale skin
Pupil appearance: size, quality, reactivity
Blood pressure: systolic, diastolic, auscultation,
palpation
Signs and symptoms
Allergies
Medications
Past pertinent history
Last oral intake
Events that lead to problem
10
Remotivation:
The Baseline Vitals and SAMPLE History are part of the
essential information necessary to obtain and document in
order to give a patient the best possible care in the field. This
information can alert the provider to call for additional
resources if necessary and can give those accepting care of the
patient at the next level of patient care a good idea of what
may be going on inside the patient’s body.
Evaluation