Vital Signs

hey guys my name is Sam and welcome to pragmatic in this week's video we're gonna be discussing vital signs what are they how to take them and how to interpret the data you receive [Music] so vital signs are essentially different tests we can run on patients that can help us determine how their body is functioning internally traditionally vital signs have included blood pressure respiratory rate and pulse rate however in recent years that list has been expanded to include spo2 cat nama tree and capnography and blood glucose measurements in today's video i'm going to go through each one of these discuss what numbers you can expect and also how to interpret the data you receive so the first vital sign we're going to talk about today is going to be pulse so your pulse is actually a measurement of your heart rate and how many times it is beating every minute when you take some of these pulse it is expressed in beats per minute a normal heart rate is between 60 and 100 beats per minute anything over 100 beats per minute is considered tachycardia and can be a sign of early signs of shock as the heart rate tries to speed up to get more oxygen to peripheral tissue but it can also be a normal finding for somebody that's exercising or somebody that is not at rest anything under 60 is considered bradycardia this can be a sign of weight shock where the heart is starting to shut down but it can also be normal for athletes to have resting heart rates under that 60 mark when we're taking any vital sign but especially pulse we want to trend these vital signs so just taking somebody's pulse does not give us a good view into how their body's functioning we have to actually take three of them to get a trend in which direction their vital signs are going in order for it to be accurate data so when you're checking somebody's pulse you want to make sure that you're using these two fingers if you're using your thumb your thumb actually has a pulse of its own and you may confuse your heart rate for the patient's which is not a mistake you want to make so when you're taking you take it with these two fingers you can check it in a couple different locations so the two most common for somebody that's in a really dire situation unresponsive they collapse in front of you you're checking them for CPR is going to be your carotid artery which is right up the side of the neck and your femoral artery which is right at the inguinal fold on the groin you want to make really sure that you are not checking the carotid artery both at this time because you might be cutting off blood flow to the brain which is not a good thing to find this you want to go find the trachea go right off to the side and there's a little indentation take these two fingers and you can kind of vary the pressure that you're feeling you can do this on yourself or somebody else just make sure that you're communicating with the patient as it can be kind of scary and intimidating to have somebody come and reach right at their neck generally speaking if somebody's conscious I'm going to be going for peripheral pulses the most common sight for peripheral pulses is going to be the radial artery which is on the thumb side of somebody's wrist you take these two fingers and push lightly right on the side of their wrist you might have to vary it going up and down and vary your pressures to find it once again you can find this on yourself or somebody else pretty easily the other place that you can find a peripheral pulse is right at the top of the foot and that's called a pedal pulse I don't usually take a pulse here because it is a lot harder to find I'm usually only going down there to see if they do have a pedal pulse and that there is circulation to their lower extremities so to actually count a pulse you're going to find where you can feel the beating of their heart you're going to take your watch and your watch should have a second hand on it and you're going to count the pulses for half a second you can do fifteen seconds you can do a full minute but I find a full minute to be a little bit long and 15 minute 15 seconds is not the most accurate once you get it for half a second you're going to multiply that number by two and that is your beats per minute that is your heart rate so once again that should be falling between 60 and 100 beats per minute while you're feeling a pulse you are not just feeling for a rate you should also be feeling for how strong it is oftentimes if somebody has a very low blood pressure you may not be able to feel pulse in the peripheral areas and you might have to go to central pulses to find that they used to say that if somebody had a blood pressure under 70 that you wouldn't be able to feel their wrist that has largely been found to be false and different people will lose their peripheral Paul as in different phases of hypotension the second vital sign we're going to be talking about is respiratory rate so your respiratory rate is how many times the patient is breathing every minute the normal rate for breathing is between 12 and 20 breaths per minute anything over 20 is considered tachypnic anything under 12 is considered Brade APNIC just like your heart rate you can have numbers outside of these ranges that are still considered normal so somebody that's run a marathon per se will have respiratory rate far above that 20 breaths per minute somebody that's asleep can oftentimes have a respirator eight well under the 12 breaths per minute so keep that in mind when you're assessing this vital sign to assess this vital sign we don't actually have to lay hands on the patient in any way you're going to be looking at them and looking at their chest rise and fall and you're going to count how many times it goes up and down in 30 seconds once again you're going to multiply that number by two and that will give you your respirations per minute just like your pulse you're not just looking at the rate you should be looking at work of breathing does it look hard for them to breathe are they try podding holding their hands over their knees this is a huge sign that somebody is air hungry and they're trying to expand the amount of room in their chest to get more air also listen for the quality of respirations do you hear anything while they're breathing in and out while stethoscopes and listening to lung sounds is great often times you can hear somebody that's wheezing or has the high-pitched Strider noise in their throat well before you put a stethoscope on their chest you should also be looking for the rhythm they're breathing in somebody that's in diabetic ketoacidosis or has a really really high blood sugar will oftentimes be breathing very very deep and rapidly these are called Kuzma respirations or somebody with severe head injury will have a crescendo of breaths followed by a period where they're not breathing and that's called cheyne-stokes so by looking at the rate and how they're breathing that's going to give you an idea of the patient's overall condition the next vital sign we're going to be discussing today is your blood pressure and your blood pressure is going to be one of the more complicated vital signs to obtain but it is not near as hard as it looks so to get a blood pressure you need a blood pressure cuff which is also known as a sphygmomanometer if you want to sound smart to your friends and you need a stethoscope although this is not needed all the time and I'll explain that here in a bit so your blood pressure is expressed by your systolic blood pressure which is the amount of pressure in your veins when your heart contracts over your diastolic blood pressure which is the amount of pressure in your veins when your heart is at rest now this is measured in millimeters of mercury although we generally only say blood pressure is systolic over diastolic so 120 over 80 for example now a normal blood pressure is going to be 120 over 60 and that is considered picture-perfect but blood pressures are very subjective and very person-to-person high blood pressure is called hypertension and low blood pressure is called hypotension generally speaking anything over that 140 range for a systolic blood pressure is considered hypertensive and anything under the 120 to 100 range is considered hypotension like I just said that varies person to person somebody that generally has high blood pressure and that's a chronic condition for them when they fall down to the 120 that can be considered hypotension hypotensive for that patient so it's a really hard one to give you a hard fast range now generally speaking if you see a blood pressure under 100 this is profoundly hypotensive that being said I wake up in the morning and my blood pressure usually runs in the 80s so it is different person-to-person low blood pressure can be a sign of hypovolemia or a profound stage of shock and hypertension can be from a multitude of different things everything from physical exertion to a bleed in the patient's head or just stress so this vital sign is something that you should probably go research a little bit more before you're making treatment determinations based off it but it is a good thing to know how to do so to take somebody's blood pressure traditionally you take the blood pressure cuff and you want to wrap it around the patient's you have to make sure it's sized right and on most blood pressure cuff there is an arrow and a range and that arrow should be within that range for that patient a cuff that's too big or too small will give you inaccurate readings you're going to put that over the bicep making sure that the joint is exposed and you're gonna get relatively tight on the arm you're going to close the valve and you're going to pump the blood pressure cuff up to about 200 millimeters of mercury as denoted on the gauge of the blood pressure cuff you're going to take your stethoscope you're going to put it over the joint there right over the artery and you're going to slowly start to deflate the cuff and tell you here beats once you hear beats whatever number the dial is on that is your systolic blood pressure as you continue to release air from the bag it's going to slowly stop hearing the beats and when you stop hearing those beats that is your diastolic blood pressure wherever that arrow is on the dial if you do not have a stethoscope or if it's too loud to hear with the stethoscope you can actually find their radial pulse pump the cuff up to where it was before and slowly start to release the cuff once you start feeling a pulse that is their their systolic blood pressure however keep in mind when you're taking this this is called a palpated blood pressure you cannot get a diastolic measurement so this would be expressed as 120 over palp now blood pressures can also be taken by automated machines you'll see them in ambulances a lot attached to the cardiac monitor and then you also see in places like Walgreens these are great but they can be very inaccurate and they can give you bad numbers and cause you to treat your patient differently I would always recommend taking a manual blood pressure with a stethoscope and a blood pressure cuff before using an automated device one big thing to look for in blood pressure measurement is that if you have somebody that is tachycardic so they have a high heart rate above 100 and they are hypotensive so they have a lower blood pressure sure that is a sign of decompensated shock the body is trying to pump more blood to the vasculature however it is not able to maintain the appropriate pressure in the veins this is a really bad sign and a really late sign of shock that needs to be intervened on immediately the next vital sign we're discussing is going to be pulse oximetry so pulse oximetry is the measurement of haemoglobin saturated by oxygen this is obtained using a pulse oximeter you can get really small ones like this they have some that are attached to cardiac monitors you can spend ten dollars you can spend $200 on these devices Amazon has a couple really good ones however you have to be really careful buying these especially if you're going to be making treatment decisions based off the data this provides so for a pulse oximeter the normal range for oxygen saturation is between 94% and 100% we really want that oxygen saturation above 94 if you see somebody that is under that 94% we're generally giving them some supplementary oxygen that being said there are people that run low normally anybody that has COPD emphysema or some other respiratory issues may have low to saturations on the flip side of that 100 can be normal as somebody that's just breathing room air however when somebody is having chest pain or has stroke like symptoms we want to be really careful by giving them oxygen we do not want to give them 100% oxygen and get that to 100% we'd rather see that 99 percent that's because if we saturate somebody's blood with too much oxygen that is actually a vasoconstrictor and we can actually decrease their cardiac blood supply by almost 30% by giving them too much oxygen pulse oximeters are also predominantly fairly inaccurate if somebody's hand is warm or cold you will get an inaccurate reading also if somebody has Co poisoning their pulse oximeter will read 100% but that is only because their hemoglobin has been taken over by the carbon monoxide molecules so like I said the normal range is between 94 and 100 percent on this it will also give you a heart rate which is a good measurement however you should always take that heart rate manually first when it comes to pulse oximetry always treat the patient not the number so if you see somebody that is at 100% but they have cyanosis blueness around the lips or the nail beds they're having extreme difficulty breathing do not withhold oxygen from that patient as this might not be an accurate reading one huge pet peeve of mine is when people say oh two stat it is not an o2 statistic it is an o2 saturation so when you're saying this it is an o2 Sat well I do not have a glucometer with me blood glucose analysis is considered a vital sign and we are taking that on almost every single patient we transport to the hospital so your blood glucose is just a small drop of blood that's obtained usually from a finger stick and that is put into a machine called a glucometer now that glucometers readings should be between 90 and 120 although once again that number can fluctuate slightly somebody that is really hypoglycemic so they have a low blood sugar below that 90 to 80 range can be lethargic that's usually because they've taken their insulin and did not eat anything that requires them to have sugar administered to them if they're conscious we give them sugar in their gum that's called the buccal route with oral glucose if they're unresponsive you can give them glucagon which is an iamb injection in the arm or you can give them d50 or D 10 which is dextrose 10% or dextrose 50% through their IV we want to make sure that we're never putting sugar anything into anybody's mouth that cannot protect their own airway so somebody that's unresponsive we have to either be doing the glucagon or the d-10 somebody whose blood sugar is over that 120 range when they start getting to the 200-300 range they can start becoming slightly lethargic this is generally a long-term thing and is not an acute issue so generally with these patients we transport to them them to the hospital and they have their blood sugar regulated by their insulin I'm not gonna go super in-depth into the blood glucose because that is a whole nother topic that I'll probably cover in another video just know that it is considered a vital sign for a lot of people I mentioned in the beginning of this video nog Rafi so capnography is something that's insanely complicated I'm not going to go into it in this video because it is something that deserves a couple videos in and of itself just know that capnography is the measurement of exhale co2 normal ranges are between 35 and 45 and it's something that ALS services and even some basic life support services are using to determine the overall medic metabolic function of patients if by chance you're coming to interview with me at my job just know that when you say I want to set a vital signs in your case scenario we give you during your interview I would like you to get capnography which is why I included it in this video so if you have any questions about anything I talked about today please leave them in the comments down below this is a cursory overview and there's a ton to know about vital signs just remember do everything manually don't make up your respirations which is a temptation a lot of us face and make sure that you are correlating the data with a trend so taking at least three sets of vital signs if somebody is really sick and you're worried about their hemodynamic instability you should be taking vital signs every five minutes if somebody is stable it's acceptable you taking vital signs every 15 minutes one thing to mention about vital signs is that children will oftentimes have different vital signs than adults in terms of respiratory rate and pulse rate their pulse and restorations will actually be higher the younger they are so keep that in mind the ranges I gave you are strictly for adult patients well I said if you have any questions please leave them in the comments down below and I will see you next week [Music]

Channel: PrepMedic

Views: 90,465

Keywords: Vitals, Vital signs, Blood pressure, Pulse, Paramedic, EMT, EMS, 911, Ambulance, First aid, First aider, Emergency, Emergency care, Prepmedic, Medicine

Id: UtPQFWkgaI0

Length: 17min 44sec (1064 seconds)

Published: Sun Feb 23 2020