Vital Signs and SAMPLE History
- Identify the components of vital signs.
- Describe the methods used to obtain breathing rate.
- Identify the attributes that should be obtained when assessing breathing. - Differentiate between shallow, labored and noisy breathing.
- Describe the methods to obtain a pulse rate.
- Identify the information obtained when assessing a patient’s pulse.
- Differentiate between a strong, weak, regular and irregular pulse. - Describe the methods used to assess the skin color, temperature and condition (capillary
refill in infants and children).
- Identify the normal and abnormal skin colors.
- Differentiate between pale, blue, red and yellow skin color. - Identify the normal and abnormal skin temperature.
- Differentiate between hot, cool and cold skin temperature.
- Identify normal and abnormal skin conditions.
- Identify normal and abnormal capillary refill in infants and children. - Describe the methods used to assess the pupils.
- Identify normal and abnormal pupil size.
- Differentiate between dilated (big) and constricted (small) pupil size. - Differentiate between reactive and non-reactive pupils and equal and unequal pupils. - Describe the methods used to assess blood pressure.
- Define systolic blood pressure.
- Define diastolic blood pressure.
- Explain the difference between auscultation and palpation for obtaining a blood pressure. - Identify the components of the SAMPLE history.
- Differentiate between a sign and symptom.
- State the importance of accurately reporting and recording the baseline vital signs. - Discuss the need to search for additional medical identification. - Explain the value of performing the baseline vital signs.
- Recognize and respond to the feelings patients experience during assessment. - Defend the need for obtaining and recording an accurate set of vital signs. - Explain the rationale of recording addition sets of vital signs. - Explain the importance of obtaining a SAMPLE history.
I. General Information
A. Chief complaint - why EMS was notified
B. Age - years, months, days
C. Sex - male or female
II. Baseline Vital Signs
A. Breathing - assessed by observing the patient's chest rise and fall.
1. Rate is determined by counting the number of breaths in a 30-second period
and multiplying by 2. Care should be taken not to inform the patient, to avoid
influencing the rate.
2. Quality of breathing can be determined while assessing the rate. Quality can
be placed in 1 of 4 categories:
a. Normal - average chest wall motion, not using accessory muscles.
b. Shallow - slight chest or abdominal wall motion.
(1) An increase in the effort of breathing
(2) Grunting and stridor
(3) Often characterized by the use of accessory muscles
(4) Nasal flaring, supraclavicular and intercostals retractions in
infants and children
(5) Sometimes gasping
d. Noisy - an increase in the audible sound of breathing. May include
snoring, wheezing, gurgling, crowing.
1. Initially a radial pulse should be assessed in all patients one year or older. In patients less than one year of age a brachial pulse should be assessed. 2. If the pulse is present, assess rate and quality.
a. Rate is the number of beats felt in 30 seconds multiplied by 2.
b. Quality of the pulse can be characterized as:
3. If peripheral pulse is not palpable, assess carotid pulse.
a. Use caution. Avoid excess pressure on geriatrics.
b. Never attempt to assess carotid pulse on both sides at one time.
C. Assess skin to determine perfusion.
1. The patient's color should be assessed in the nail beds, oral mucosa, and conjunctiva.
a. In infants and children, palms of hands and soles of feet should be
b. Normal skin - pink
c. Abnormal skin colors
(1) Pale - indicating poor perfusion (impaired blood flow)
(2) Cyanotic (blue-gray) - indicating inadequate oxygenation or
(3) Flushed (red) - indicating exposure to heat or carbon
(4) Jaundice (yellow) - indicating liver abnormalities 2. The patient's temperature should be assessed by placing the back of your hand on the patient's skin.
a. Normal - warm
b. Abnormal skin temperatures
(1) Hot - indicating fever or an exposure to heat.
(2) Cool - indicating poor perfusion or exposure to cold.
(3) Cold - indicates extreme exposure to cold.
3. Assess the condition of the patient's skin.
a. Normal - dry
b. Abnormal - skin is wet, moist, or dry.
4. Assess capillary refill in infants and children less than six years of age.
a. Capillary refill in infants and children is assessed by pressing on the
patient's skin or nail beds and determining time for return to initial color.
b. Normal capillary refill in infants and children is < 2 seconds.
D. Pupils are assessed by briefly shining a light into the patient's eyes, and determining
size and reactivity.
1. Dilated (very big), normal, or constricted (small).
2. Equal or unequal
3. Reactivity is whether or not the pupils change in response to the light.
a. Reactive - change when exposed to light
b. Non-reactive - do not change when exposed to light
c. Equally or unequally reactive
E. Blood pressure
1. Assess systolic and diastolic pressures.
a. Systolic blood pressure is the first distinct sound of blood flowing
through the artery as the pressure in the blood pressure cuff is released.
This is a measurement of the pressure exerted against the walls of the
arteries during contraction of the heart.
b. Diastolic blood pressure is the point during deflation of the blood
pressure cuff at which sounds of the pulse beat disappear. It represents
the pressure exerted against the walls of the arteries while the left
ventricle is at rest.
c. There are two methods of obtaining blood pressure.
(1) Auscultation: In this case the EMT-Basic will listen for the
systolic and diastolic sounds.
(2) Palpation: In certain situations, the systolic blood pressure
may be measured by feeling for return of pulse with deflation of the cuff. 2. Blood pressure should be measured in all patients older than 3 years of age. 3. The general assessment of the infant or child patient, such as sick appearing, in respiratory distress, or unresponsive, is more valuable than vital sign numbers.
F. Vital sign reassessment
1. Vital signs should be assessed and recorded every 15 minutes at a minimum in a stable patient.
2. Vital signs should be assessed and recorded every 5 minutes in the unstable patient.
3. Vital signs should be assessed following all medical interventions.
III. Obtain an SAMPLE history.
1. Sign - any medical or trauma condition displayed by the patient and identifiable by the EMT-Basic, e.g., Hearing = respiratory distress, Seeing = bleeding, Feeling = skin temperature.
2. Symptom - any condition described by the patient, e.g., shortness of breath.
3. Environmental allergies
4. Consider medical identification tag
c. Birth control pills
3. Consider medical identification tag
D. Pertinent Past History
4. Consider medical identification tag
E. Last oral intake: Solid or liquid
F. Events leading to the injury or illness
1. Chest pain with exertion
2. Chest pain while at rest