VITAL SIGNS

VITAL SIGNS

THESE ARE SIGNS USED BY NURSES,

PARAMEDICS AND PHYSICIANS to follow-up

the patient's condition or to detect any variation in

them.

Pulse

Respiration

Temperature

Blood pressure

Pupils

Colors

Level of consciousness

Stroke pain

Ability to move

The vital signs include:

PULSE

Reflects the rate of the heart beat

Felt where an artery passes over a bone near the

surface (superficial) of the body.

Normal heart rate ranges between 60-90/min

RESPIRATION

It is the means by which oxygen enters the blood

through the lungs during breathing in and carbon

dioxide is expelled during breathing out.

Normal respiratory rate is 12-16/min

TEMPERATURE

Average body temp is 37 degrees centigrade

Take by a clinical thermometer

BLOOD PRESSUREIt means the force required by the heart to pump blood from

the ventricles of the heart into the arteries. It is measured in

systolic and diastolic pressure.

Systolic- is known as the force to pump blood out of the heart

Diastolic- is known as the resting period when the pressure

falls, also known as the relaxation period of the heart pump

Normal B.P. 120/80 or 100/70 mm/Hg

Hypertension: High blood pressure

Hypotension : Low blood pressure

PUPILS

Check the pupils for size, equality and reactivity

Examine both eyes

COLOUR

Color of the skin and mucous membrane,

(conjunctiva, inside of the lips)

LEVEL OF CONSCIOUSNESS

This is used during cardiac arrest, head injuries and

any comatose patient to assess responsiveness

REACTION TO PAIN

in case of cardiac arrest, response to painful

stimuli can be tested

a pin or sharper object can be used in assessing

reaction to pain

ABILITY TO MOVE

If the patient is conscious and if

spinal or neck injury is suspected

assess the patient's ability to

move his upper and lower

extremities.

PATIENT ASSESSMENT

Assessment is the cornerstone of excellent patient care.

The first goal in assessment is to find out the patient's

condition.

Next, all life-threatening conditions must rapidly be found

and urgent intervention and resuscitation must be initiated.

Finally, all conditions needing attention prior to moving

the patient must be done quickly and efficiently.

Scene assessment

Look for, identify, or remove any life-threatening

hazards if possible so as to avoid any injury to the

rescuers and any further injury to the injured.

Failure to perform preliminary action may put your

life at risk as well as that of your patient.

Aspects of Scene Survey:

Before you approach the victim:

Assess the scene for hazards. "Is it safe to

approach the victim?"

Note the mechanism of injury

Note the number of victims

Note special equipment needed

"Do you need additional help?"

The field of examination consists of:

Primary Survey

Secondary Survey

PRIMARY SURVEY

Is a process carried out to detect life-threatening problems

This exam should not take over 2 minutes.

The emphasis here is on rapid evaluation and movement

to the hospital with critical patients.

The five types of the primary survey are:

Airway and cervical Spine Control

Breathing

Circulation (Check pulse) and Hemorrhage Control

Disability (Neurological Examination) -see if the patient is

alert, responds to verbal stimulus, responds to painful

stimulus and unresponsive

Expose and Examine

SECONDARY SURVEYOBJECTIVE: To discover medical and injury-related problems that

do not pose an immediate threat to survival but may if allowed to

go untreated.

Assessment:

The secondary assessment is a head-to-toe evaluation of the patient.

All related and significant injuries and identified in correlation with

the physical findings. This is accomplished on a region-by-region

basis beginning with the extremities concluding with the

neurological examination

EXAMINATION OF THE HEAD AND NECK IN TRAUMA PATIENTS

 SCALPCheck for lacerations and contusions, Is there blood in the hair? Do not move the patient's head

during this procedureCheck back of the head for blood 

SKULLPalpate for tenderness or depressionPay attention to the area over the MASTOID BONE for fracture

EAR/NOSECheck for discharge of fluids or bloodClear fluid (CSF) from the nose or ears indicative of skull

fracture

EYES

Check for trauma or swelling about the orbit

Ecchymoses around the eyes(coon's eyes) without evidence of direct

injury are a clue to skull fracture

SCLERAE

Check for icterus (yellowish discoloration)

PUPLIS

Note size and shape

Equal or unequal

Reaction to light?

Observe motion of the eyes 

NECK

In the trauma patient, gently palpate the back of the

neck for tenderness.

If spinal injury is strongly suspected, immobilization

of the neck (spine) should precede all other

maneuvers of the secondary survey.

TRACHEA

Inspect and palpate to determine whether it is in the

midline

The trachea will deviate an obstructed bronchus from a

simple pneumothorax

The trachea will deviate away from a tension

pneumothorax or significant hemothorax

CHEST

Check and inspect for minor deformities

Observe movement

check for Contusions and Abrasions

Palpate chest cage

Feel each rib and the clavicles individually

Evaluation of internal structures is best done with the use

of a stethoscope.

ABDOMEN

Look for signs of blunt or penetrating trauma

Feel for tenderness

If the abdomen is painful to gentle pressure…internal

bleeding

EXTREMITIES

Examination of the extremities should begin with

clavicle (collar bone) or pelvis and proceed to the most

distal portion of that extremity

Each bone should be individually evaluated visually for

deformation and surrounding hematoma or ecchymosis

X-ray examination …….for fracture

NEUROLOGICAL EXAM:

Pupil response: Are they equal or unequal?

Eye opening: What stimuli are required to make the

patient open his eyes?

Vocal?

Tactile?

Pain? 

Verbal response:

Does the patient talk?

Speech is the highest brain function

Incomprehensible speech or an inability to speak are

indications of brain dysfunction

Motor response: Extremity responses to stimulation

can indicate a number of things about the brain

function. These responses are either purposeful or not.

Purposeful responses include obeying commands

CARE OF

UNCONSCIOUS

PATIENTS

CONSCIOUSNESS:Implies awareness and attention to one's surroundings

and to oneself.

Consciousness is maintained by impulses mediated via

Grey Matter in the Reticular Activating System (R.A.S.)

Sleep is a physiological process which is usually

accompanied by reduction of impulses in the R.A.S. The

individual is easily arousable from sleep and basic

protective reflexes are also intact.

UNCONSCIOUSNESS

Unconsciousness is different from normal sleep in that

unconscious subjects are not usually arousable and

quite often, there is loss of or interference with basic

protective reflexes such as:

Maintenance of free airway

Coughing and swallowing

Withdrawal from noxious stimuli etc.

Unconsciousness may be:

Partial (semi-coma or stupor)Complete (deep coma)

Accurate diagnosis of the cause of Unconsciousness

is important for SPECIFIC TREATMENT but

for the GENERAL CARE of the patient, level of

consciousness is more important.

CAUSES OF UNCONSCIOUSNESS INCLUDE:

SHOCK

ASPHYXIA

POISONING

HEAD INJURY

CEREBRO-VASCULAR ACCIDENTS (STROKE)

EPILEPSY

HYSTERIA

INFANTILE CONVULSIONS

HYPOTHERMIA OR HYPERTHERMIA

DIABETES MELLITUS – HYPO/HYPER

FAINTING/SYNCOPE, VASOVAGAL ATTACKS

HEART ATTACKS

OTHERS E.G.

- MENINGO ENCEPHALITIS

- FLUIDS AND ELECTROLYTE DISORDERS

CARE

Emergency care or first aid

Long term care-usually as inpatient

1 -EMERGENCY CARE

General rules

Remove the casualty from any obvious hazard and

call for help. Be aware that injury to the spine may

be present.

Check the breathing and remove any airway

obstruction caused by flaccid tongue, food particles,

blood clots, denture etc.

If subject is not breathing or breathing is inadequate,

commence artificial respiration immediately. This is

easier with the patient in supine position.

Next, check the pulse and out external chest

compression if there is no pulse. In the absence of both

pulse and breathing, carry out the sequence of one-

rescuer CPR until help arrives.

If both breathing and pulse are present, loosen all tight

clothing, and treat any obvious life threatening injury

such as profuse bleeding.

Give oxygen by mask if available and elevate the legs if

the pulse is feeble or fast.

Place and support the casualty in the semi-prone or

"tonsil" position.

Do not leave the patient unattended unless absolutely

necessary and constantly watch the breathing and check

the pulse.

Do not administer any oral fluids or food to an

unconscious subject.

Keep warm with blanket if necessary but do not apply

heat.

Remove the subject to medical aid (hospital) as soon as

possible and preferable on a stretcher.

2 -LONG TERM CARE

In order to optimize the care of the unconscious patient in a

hospital, it will be helpful to know the cause of the

unconsciousness.

This will involve the usual steps of history taking,

examination, investigations etc.

General care is however necessary, no matter the cause of

consciousness is important in determining the extent of care

required and may involve doctors, nurses, physiotherapists,

nutritionists etc. It may also require an intensive care unit.