• Quick, thorough assessment to:
  • Identify a patient's needs
  • Provide proper Emergency Medical Care

• Name
• Age - Normal vital signs differ
• Gender
• Chief Complaint
• Major signs and symptoms that patient reports
• Includes any significant gross, apparent injuries
• Symptoms:
  • Problems or feelings the patient reports to you
• Signs:
  • Objective conditions that can be seen, heard, felt, smelled, measured by you or someone else
• Signs and Symptoms that occurred you I arrived may be reported by the patient or others at the scene
• Essential to understanding the sequence of events, and may include signs that are no longer present
• Report how and/or when the signs and symptoms began

• Signs and Symptoms of the episode: What signs and symptoms occurred at the onset of the incident?  Does the patient report pain?
• Allergies:  Is the patient allergic to any medications, food, or other substance?  What reactions did the patient have to any of them?  If the patient has no known allergies, note this on the run report as "no known Allergies, or "NKA"

• Medications:  What medications was the patient prescribed?  What dosage was prescribed?  How often is the patient supposed to take the medication?  What prescription, over-the-counter, medications, and herbal medication has the patient taken in the last 12 hours?  How much was taken and when?
• Pertinent Past History:  Does the patient have any history of medical, surgical, or trauma occurrences?  Has the patient had a recent illness or injury, fall, or blow to the head? 

• Last Oral Intake:  When did the patient last eat or drink?  What did the patient eat or drink, and how much was consumed?  Did the patient take any drugs or drink alcohol?  Has there been any other oral intake in the last 4 hours?
• Events leading to the injury or illness:  What are the key events that led up to this incident?  What occurred between the onset of the incident and your arrival?  What was the patient doing when this illness started?  What was the patient doing when this injury happened?

OPQRST

(Questions you should ask when obtaining patient history)

Esp. helpful when assessing for possible heart attack

• O=Onset:  When did the problem begin and what caused it?
• P=Provocation or Palliation:  Does anything make it feel better or worse?
• Q=Quality:  What is the pain like?  Sharp, dull, crushing,tearing, etc?

• R=Region/Radiation:  Where does it hurt?  Does the pain move anywhere?
• S=Severity:  On a scale of 1 - 10, How would the patient rate pain?
• T=Timing of the Pain:  Has the pain been constant, or does it come and go?  How long have they had the pain?

Baseline Vital Signs

The 1^st set of vital signs obtained

• Vital Sings - key signs used to evaluate the patient's condition
• By periodically reassessing vital sings and comparing them to the baseline set, you will be able to identify any trends in the patient's condition, particularly whether the patient's condition is becoming worse

• Always include:
  • Patient's Respirations
  • Pulse
  • Blood Pressure 
• Other Key Indicators:
  • Skin temperature and condition in adults
  • Capillary refill in children
  • Pupillary reaction
  • Level of consciousness

• Spontaneous Respirations: patient is breathing without assistance
• 2 Distinct phases in a 1:3 Ratio:
  • Inhalation 1/3 amount of time of
  • Exhalation (passive)

• Watch for patient's chest rise and fall
• Feel for air through the mouth and nose 
• Listen to breathing sounds - should be equal on both sides of the chest
• Speaking patient has spontaneous respiration
• Determine breathing:
  • Rate
  • Quality 
  • Depth

• Determined by counting the # of breaths in 30 sec. X 2
• Normal Adults: 12 -20 breaths/min
• Children: 15 - 30 breaths/min
• Infants: 25 - 50 breaths/min

• Normal:  
  • Neither shallow nor deep
  • Equal chest rise
  • No use of accessory muscles
• Shallow:  
  • Decreased chest or abdominal wall motion
• Labored:  
  • Increased breathing effort
  • Use of accessory muscles
  • Posible gasping
  • Nasal flaring, supraclavicular intercostal reactions in infants or children
• Noisy:  
  • Increase in sound of breathing, including snoring, wheezing, gurgling, crowing, grunting, and stridor

• Rhythm
• Note rhythm:  
  • If respirations vary or change frequently they are considered irregular
  • Be sure to note this (regular or irregular)

• Effort
• Does not effect patient's:
  • Speech
  • Posture
    • Tripod
    • Sniffling (patient sits upright with head and chin thrust forward)
  • Positioning
• Cardiac arrest in generally caused by respiratory arrest in infants and small children:

Respiration

(Quality)

• Noisy Breathing
• Stridor: a harsh, high pitched, crowing sound
  • Indicative of partially obstructed airway
• Bubbling or Gurglng:
  • Indicative of fluid in the airway
• Wheezing or snoring
• Coughing up yellow/green sputum:
  • Indicative of respiratory infection
• Cough up blood or frothy whitish/pinkish sputum
  • Indicative of injury or congestive heart failure

• Depth
• Tidal Volume:  The amount of air that is exchanged in each breath
• Pulse Oximetry:  Instrument to evaluate the effectiveness of oxygenation (95% - 100%)
• Vasoconstriction:  narrowing of the blood vessels

• Pulse:  The pressure wave that occurs as each heartbeat causes a surge in the blood circulating through the arteries
• Responsive patients:  Radial pulse at the wrist
• Unresponsive Patients:  Carotid pulse in the neck
• Infants:  Brachial Pulse in the medial area (underside) of the upper arm

• 30 secs. X 2
• Irregular or slow pulse - count for the full minute
• Normal pulse rates:
  • Adults:  60 - 100
  • Children:  70 - 150
  • Infants 100 - 160
• Tachycardia - Rate greater than 100 beats/min
• Bradycardia: Rate less than 60 beats/min

• Always report pulse strength
• Normal = Strong
• Bounding = stronger than normal
• Weak thready = difficult to feel

• Regular or Irregular
• No matter what the Rate
• contractions should be the same
• Regular Rhythm
• Irregular pulse is found in patients with sign and symptoms that suggest a cardiovascular problem - Contact ALS!

• Color:  
• Determine adequacy of Perfusion - circulation of blood within the organ or tissue
• Conjunctiva  delicate membrane lining of the eyelids
• Cyanosis - blue or gray
• Check soles of feet and palms of the hands in infants
• High blood pressure = flushed skin
• Jaundice = live disease or dysfunction
• Sclera =white portion of the eye

• Normally = warm
• Significant fever or sunburn, hyperthermia = hot
• Early shock, mild hypothermia, profound shock,frostbite = cold

• Normal skin is dry
• Wet skin (diaphoretic) = early stages of shock
• Dry Skin = suggests a problem

Evaluated to assess the ability of the circulatory system to restore blood to the capillary system

Can be effected by the patients

body temperature

Position

• Preexisting conditions
• Capillary refill within 2 second
• CRT<2 - poor peripheral circulation
• CRT>2
• Bluish color = capillaries refilling with vein drawn blood
• Delayed CR when patient is cold

• A decrease in blood pressure:
  • Loss of blood or its fluid components
  • Loss of vascular tone and sufficient arterial constriction to maintain the necessary pressure even without any actual loss of fluid or blood
  • Cardiac pumping problem

• Any of the previous conditions result in drop of circulation
• Heart rate increases
• Arteries constrict
• Normal BP is maintained by:
  • Decreasing blood flow to the skin and extremities
  • Blood flow is diverted to the vital organs
• Decreased BP late sign of shock - critical decompensation has begun

• Elevated BP - body's defenses act to reduce it
• Causes:  Head injury
• May cause rupture or critically damage arterial system

• Measure BP in all patients over 3
• Systolic - the maximum pressure to which the arteries are subjected
• Increased pressure that is caused along the artery with each contraction (systole)
• Diastolic - the minimum pressure to which the arteries are subjected
• The residual pressure that remains in the arteries in the relaxing phase
• Measured in mm of mercury (mm HG)

• 3 cuff sizes
  • Adult
  • Thigh
  • Pediatric
• Must select the right size:
• Cuff that is too small may result in a falsely high reading
• Cuff that is too large may result in a falsely low reading

• The method of listening to body sounds with a stethoscope
• Steps:
• Patient arm extended - palm up
• Cuff across the upper part of the arm - distal edge about 1" above the elbow crease
• Palpate the brachial artery
• Place the diaphram of the stethoscope over the artery
• Close the valve, pump the ball
• When pulse sound stops - open the valve and release the remaining air quickly
• Document findings

• Measure BP when you can't hear it
• Steps:
  • Palpate the radial pulse
  • Cuff and turn valve until the pulse disappears
  • inflate 30mm Hg
  • Open valve slowly
  • observe dial when pulse resumes
• Will only yield a systolic BP

• Hypotension - BP lower than normal range
• Hypertension - BP higher than normal range
• Normal ranges:
  • Adults - 90 -140 Systolic
  • Children (aged 1 - 8) - 80 - 100 Systolic
  • Infants (newborn - 1 yr.) 50 - 95 Systolic

• Determined by:
• Appropriateness of responses
• Patient's understanding and mental activity
• May indicate inadequate perfusion

AVPU Scale

A rapid method of assessing the patient's level of consciousness 

• A = Awake and Alert
• V = Responsive to Verbal stimuli
• P = Responsiveness to Pain
• U = Unresponsive

• Assume the patient has depressed brain function as the result of CNS depression or injury if Pupils show:
  • Become fixed, no reaction to light
  • Dilate with the introduction of bright light and constrict whe light is removed
  • Become sluggish instead of brisk
  • Become unequal in size
  • Become unequal in size when bright light is introduced into or removed from 1 eye

• Injury of the brain or brain stem
• Trauma or stroke
• Brain tumor
• Inadequate oxygenation or perfusion
• Drugs or toxins