Level of Consciousness

INTRO TO EMS NAME: ______PERIOD: ______SKILL LAB #1 – VITAL SIGNS

This lab will introduce you to the common procedures for assessing vital signs. You will be required to measure the vital signs of various classmates, and answer review questions at the end of the skills lab.

LEVEL OF CONSCIOUSNESS The level of consciousness must be constantly assessed and reassessed. Alertness and awareness to the environment, and response to stimuli and pain are measured. The AVPU Scale determines a score for level of consciousness.

Procedure: 1. How would you assess each level of responsiveness using the AVPU scale? Why is each finding significant?

2. Using the AVPU Scale for reference, determine the level of consciousness of two classmates.

Pt 1 Pt 2 ALERT VERBAL (STIMULI) PAIN (STIMULI) UNRESPONSIVE

RESPIRATORY RATE Respiration is the process of exchanging oxygen for carbon dioxide within the body.

Materials needed:  watch or clock

Procedure: 1. Measure respiratory rate while seated and in the supine position. Perform two trials using different classmates. Sounds Rate Rate Depth Ease (wheezing, gasping, (breaths per (breaths per (shallow, deep, gurgling, crowing, (difficult, Status minute) minute) normal) coughing) labored, light) Seated

Supine

2. You respond to a call where you find a patient exerting a lot of effort to breathe. How might that affect how you proceed with the remaining vital signs? Would you treat the problem first, and if so, in what way?

PULSE RATE The pulse is the direct measurement of the heart’s function. Rate, strength, and rhythm are assessed. An abnormal pulse can indicate trauma.

Materials needed:  watch or clock

Procedure: 1. Measure pulse at the following sites and document your measurements. Use a different classmate for each site. Strength Rhythm Site Interval Rate (bpm) (weak, strong) (regular, irregular)

Radial 60 sec Brachial 15 sec Carotid 30 sec

Femoral 30 sec

2. What factors could contribute to making the heart rate faster? What factors could contribute to making the heart rate slower?

3. You respond to the home of an elderly female seated on her sofa and complaining of weakness. She is pale and you cannot locate a radial pulse. What might you consider regarding positioning the patient?

2 3 PERFUSION Perfusion refers to the amount of oxygen reaching the tissues. It is measured using a capillary refill—the time it takes for capillaries to refill with blood after being blanched.

Procedure: 1. Measure the capillary refill of three classmates. Record your findings in the table below. Findings (time to refill, normal vs. abnormal) Digit blanched: Digit blanched: Digit blanched:

2. How would a cold environment affect capillary refill time?

BLOOD PRESSURE Blood pressure is a direct measurement of the pressure of the blood against arterial walls. The measurement is taken with a sphygmomanometer (blood pressure cuff) and stethoscope, and read in a systolic/diastolic fashion. The process is known as auscultation. Blood pressure can also be measured through palpation at the radial artery using only a blood pressure cuff.

Materials needed:  manual sphygmomanometer  Stethoscope  Alcohol swabs

Procedure: 1. Auscultate three classmate’s blood pressure using the right arm.

Pressure (mm Pressure (mm Pressure (mm Hg) Hg) Hg) Systolic Diastoli c

2. Palpate three classmate’s blood pressure using the left arm.

Pressure (mm Pressure (mm Pressure (mm Hg) Hg) Hg) Systolic

3. Discuss the difference between a blood pressure obtained through auscultation and one that has been palpated. Why might one be more accurate than the other?

4. When might the EMR find it necessary to obtain a blood pressure through palpation?

SKIN SIGNS

4 Skin color can be an indicator of trauma or disease. Skin can appear reddish, whitish, bluish, or yellowish in appearance. Specific body parts are used to determine these indications.

Procedure: 1. Record the appearance of two classmate’s skin at the nail beds, lips, and ears using the scientific terms learned in lecture.

Skin Nail beds Lips Ears Patient 1

Patient 2

2. What causes pale skin? What causes blue skin? How might these signs affect the treatment actions the EMR takes?

3. How do skin signs relate to the body systems?

PUPILS The pupils indicate a measurement of the nervous system in response to visual stimuli. Size and response are measured and noted using the acronym PERL.

Materials needed:  Penlight

Procedure: 1. Identify and record pupil size under two conditions: bright light and darkness. Spend 2 minutes outside under bright light. Record pupillary size. Spend 2 minutes in total darkness. Record pupillary size. Immediately after recording pupil size, perform a penlight sweep on both eyes. Record the pupillary reaction. Size Reaction (normal, constricted, (equal, unequal) dilated) Bright light N/A Complete darkness

2. You have a patient in no apparent distress. You note that one pupil is larger than the other. What should you do?