Vital Signs

 Vital signs are a person’s pulse rate, temperature, and respiratory rate as defined by Webster’s II New College Dictionary. But in truth for EMS workers there is so much more to it, including blood pressure, pulse oximetry (aka pulse ox), blood sugar, pupil and capillary reaction, pain scale, level of consciousness, AVPU scale, the Glasgow Coma Scale, an APGAR Scale and if there is advanced life support they may give you a reading from the cardiac or heart monitor. This training will help to explain what these are, help you to understand how important this information can be and why it has to be relayed accurately. 

Pulse – This is how fast the person’s heart is beating as well as the rhythm (thready, irregular, weak, strong, nonexistent). The pulse varies with age. A newborn or infant can have a heart rate of about 120-160 beats per minute. A toddler's heart will beat about 100-120 times per minute, an older child's heartbeat is around 90-110 beats per minute, adolescents around 80-100 beats per minute, and adults pulse rate is anywhere between 60 and 100 beats per minute. 

Temperature – is important when dealing with a hot or cold related incident. The average body temperature is 98.6 ° F.  A temperature recording gives an indication of the core body temperature which is normally tightly controlled as it affects the rate of chemical reactions in the body.

Respirations – Are how fast a person is breathing. Respiration rates may increase or decrease with fever, illness, or other medical conditions. When an EMT describes how a person is breathing they may say the patient is breathing normally, shallow, the breathing may be labored, wheezing, tight, or they may even a say there is a rattling or gasping sound.  Respiratory rates change depending on the age of a patient. Neonates (up to 28 days old) breathe around 40-60 times per minute, where infants are between 25 and 50. Children breathe 15-30 times and adults usually between 12-20 breaths per minute. 

Blood Pressure (BP) – is the pressure exerted by circulating blood upon the walls of blood vessels. You will normally hear 2 numbers, given as 120 over 80 for example. The top number or systolic number, is the peak pressure exerted on the arteries when the ventricles, or lower chamber of the heart, are contracting while the bottom number or diastolic, is the minimum pressure on the arteries when the atrium, or upper chambers of the heart, are contracting. Blood pressures can change even for a person at rest depending on the time of the day. Average blood pressures for infants are between 80/60, children 100/60 and adults 110/70. Occasionally you will hear the EMT say just 1 number by palpation, for example 120 by palpation. This means they were unable to use their stethoscope to take the blood pressure and instead used the pulse point at the wrist and are unable to get a diastolic number in this fashion. 

Pulse Oximetry (aka pulse ox) – Measures how much oxygen is in the person’s blood stream and tells the EMT if the patient is getting enough oxygen.  This is a non invasive machine usually placed on the person’s finger or toe. Average is 97-100% in a healthy person. 

Blood Sugar or Glucose Levels – Advise the EMT’s if a person has enough glucose, which is our body's primary source of energy, in their system. Someone with diabetes has trouble maintaining proper levels and can be given medicine to either bring the sugar level down or up depending on the problem. Average for all ages is 70-110

Pupillary Reflex – The pupils in the eye dilate and contract depending on the amount of light available.  The medic may say that the pupillary reaction is normal or slow, the pupils are dilated and fixed or they are of an unequal size. This can be an indication that the person has a narcotic or illegal drug of some sort in their system or that the patient is suffering from some sort of head trauma. 

Capillary Refill – is a quick test performed on the nail beds to monitor dehydration and the amount of blood flow to tissue. Pressure is applied to the nail bed until it turns white, indicating that the blood has been forced from the tissue. This is called blanching. Once the tissue has blanched, the pressure is removed. Since tissues need oxygen to survive and oxygen is carried to various parts of the body by the blood (vascular) system, this test measures how well the vascular system works in a patients hands or feet, the parts of your body that are farthest from the heart. If there is good blood flow to the nail bed, a pink color should return in less than 2 seconds after pressure is removed. Blanch times that are greater than 2 seconds may indicate dehydration, shock, or hypothermia. 

Pain Scale – Patients are asked to rate their pain from 0, meaning no pain, to 10, which would the worst, most intense pain they can imagine. This is very helpful with patients with chest, back and abdominal complaints, but not limited to these ailments. 

Level of Consciousness (LOC) – You may hear a medical person say the patient is alert and oriented x3 or to x4 (abbreviated version a/o x3/4). It depends on the questions asked. This is a neurological exam meaning they are aware of person (who they are or someone else is), place (where they are), time, and events (what just happened, who the president is etc). Some medics don’t always ask the last question so you’ll hear the x3 then. 

AVPU Scale – AVPU is also used to determine level of consciousness. A= Alert, awake and oriented x3 at minimum. V=Verbal, meaning they patient responds to verbal stimuli. It is also important to note if the patient makes appropriate or inappropriate responses. If you ask your patient, "What is your name?" and they responds with, "Flaming monkeys,"  and this isn’t their actual name, this would be an inappropriate response and shows that although he responds to verbal, he is not appropriately oriented. P=Pain, this patient will only respond to a painful stimulus like a pinch or a person rubbing their knuckles along the sternum and may moan or try to withdraw from the pain (sternal rubs are very painful!). U=Unconscious, this patient does not respond to anything. 

APGAR Score – The test was designed to quickly evaluate a newborn's physical condition after delivery and to determine any immediate need for extra medical or emergency care and is done at 1 minute and 5 minutes after birth. The acronym stands for Activity, Pulse, Grimace, Appearance, and Respiration. Each is scaled from 0-2. These five factors are added together to calculate the APGAR score. Scores obtainable are between 10 and 0, with 10 being the highest possible score. Unfortunately notecards don't let me put in charts so you'll have to google the rest 

                  

Glasgow Coma Scale (GCS) – Is a widely used scoring system used in identifying the level of consciousness following traumatic brain injury (TBI). The numbers range from 3 to 15. The lower the number the more brain injury there could be.  There are 3 parts to the scale. E- Eye opening, M- motor response and V- Verbal response. And again...notecards don't let me put in charts so you'll have to google the rest 

It is generally agreed that a Traumatic Brain Injury with a GCS of 13 or above is mild, 9–12 is moderate, and 8 or below is severe. Mild TBI patients may experience headaches, nausea, vomiting, blurred vision, lack of coordination, dizziness and may have been unconscious for less than 30 minutes. Moderate TBI symptoms include a headache that doesn’t go away, vomiting nausea, unequal pupil dilation, confusion agitation and may have been unconscious for 30 minutes to a full day. Where severe TBI symptoms are similar to moderate ones, a patient is considered in a coma and is usually unconscious for more than 24 hours and may need special medications, emergency surgery immediately and physical, speech and occupational therapy once they wake up. 

Cardiac Monitor – This is a piece of equipment used by medical personnel with EMT – Intermediate certification and higher. This machine, also known as an electrocardiogram or EKG for short, is the one that you see on TV that does the “beep, beep, beep” giving the heart rate. It reads the heart’s electrical activity and shows it on a graph on a small monitor or can be printed out onto paper. It can have 3 different types of “leads” or wires that attach to the patients skin. The medic might say 3 lead, 5 lead or 12 lead EKG or just plain EKG, shows patient is tachy, tachycardiac, or in tachycardia and then they would give a number usually over 120 beats per minute, basically meaning the patient’s heart is beating too fast. Other terms used would be brady, or bradycardiac, bradycardia (heart beat is too slow), normal sinus rhythm (just right), V-fib (ventricular fibrillation), a-fib (atrial fibrillation), PVC (premature ventricular contraction) and asystole (flat-line or no heart beat). These are just some of the common terms you might hear and have to relay. If you wish to know more feel free to look it up online or ask someone who has medical experience.