Hi, this is Miles with Best Practice Medicine.
So far in this series, we’ve given an overview of vital signs. In this next segment, we’ll
go into what they represent in terms of patient physiology and clinical significance.
Vital signs allow the EMT to observe a patient’s condition and determine if it’s stable, improving,
or worsening. By collecting vitals at regular intervals, the EMT is able to observe trends
in the patient’s condition and prepare resources and response appropriately. Elevations in
pulse and respiratory rate indicate activation of the patient’s sympathetic nervous system,
the branch of the autonomic nervous system responsible for governing the adrenal or fight-or-flight
response. A patient exhibiting elevated pulse or respiratory
rate is working hard to keep tissues perfused and may be suffering from hypervolemia, respiratory
distress, or a ventilation-perfusion mismatch. A state of inadequate perfusion is called
shock and is a result of the body changing ventilation, pulse, and blood flow throughout
the body in order to keep vital organs perfused. In addition to elevations in heart and respiratory
rate, shock also presents with pale, cool, clammy, or diaphoretic skin and altered mental
status. In the condition of shock, blood pressure may stay the same or increase early on and
gradually decline as the patient’s compensatory mechanisms begin to tire and fail as the patient
enters decompensated shock. Be on the lookout for an upcoming video detailing the path of
physiology of shock. When interpreting blood pressure in all patients,
remember that hypotension means inadequate pressure to perfused tissues; and hypertension
can increase likelihood of stroke, heart attack, or aneurysm. A patient’s medical history and
current medications are also important to consider.
Pulse oximetry is a useful but sometimes limited tool for determining a patient’s blood oxygenation
status. When interpreting a pulse oximetry reading, remember to consider other clinical
findings and intervene if the patient shows signs of hypoxia such as cyanosis, anxiety,
or altered mental status, tripod positioning, or respiratory distress.
Low blood sugar or hypoglycemia can cause severely depressed mental status, loss of
consciousness, seizures, or depression in respiratory rate. Hypoglycemia is a severe
medical emergency that must be intervened upon quickly depending on your scope and local
protocols. A state of high blood sugar or hyperglycemia is also a serious medical condition
but sometimes presents with slower onset. There are few interventions, besides rapid
transport, available to basic level EMS providers. After initially determining your patient’s
level of responsiveness with AVPU or GCS, continually reassess by talking to your patient
and building a rapport, constantly observing for changes in responsiveness. A once talkative
patient who becomes increasingly calm or quiet may not be improving, rather they may be experiencing
a decline in mental status. This wraps up our general overview of vital
signs for pre-hospital EMS providers. We’ve hoped you enjoyed tuning into BPM TV. Thanks
for watching. We’ll see you next time.