WK1 - Lecture 4 - STUDENT - Vital Signs - Su24.pdf

DH 410 – EMERGENCIES IN DENTAL PRACTICE Lecture 4: Vital Signs  Introduction  Accurate assessment and recording of vital signs is essential  Proper use of BP cuff and stethoscope  Proper placement on arm (artery placement)  Proper size for pat...

DH 410 – EMERGENCIES IN DENTAL PRACTICE Lecture 4: Vital Signs  Introduction  Accurate assessment and recording of vital signs is essential  Proper use of BP cuff and stethoscope  Proper placement on arm (artery placement)  Proper size for patient arm (pediatric, adult, extra large)  Accurate interpretation of BP (sounds)  Accurate interpretation of Pulse & Respiration  Baseline vital signs are needed for comparison during medical emergency to determine severity  Previous charted vitals  Vitals charted for current appointment  Introduction  Vital signs  Determine the body’s ability to pump blood and breathe  Determine health status of patient  Pulse  Respiration  Blood pressure  Temperature  Oxygen Saturation  Pulse  Usual sites  Carotid in neck  Radial pulse in wrist  Brachial pulse in arm (especially children)  Femoral pulse in groin  Most common site in dental office  Radial pulse  Figure 3.1 Taking a pulse rate Grimes, E. B. (2014). Medical emergencies: Essentials for the Dental Professional. Prentice Hall.  Pulse  Normal pulse rates  Healthy adult: 60 – 100 BPM  Used to be considered 60 – 80 BPM  However, those with greater than 80 BPM are in a group at higher risk of heart of attack  https://www.health.harvard.edu/heart-health/what-your-heart-rate-is-telling-you  Athletes/Individuals who exercise: 40 – 60 BPM  Pulse  Tachycardia  Rapid pulse rate ( > 100 BPM)  Body’s attempt to increase O2 to cells  Often occurs due to fever, exercise, nervous excitement, medications or stimulant-type drugs, disease states (CHF, hemorrhage, shock)  Most often due to nervousness (in dental office)  Use relaxation techniques first  Communication  Nitrous Oxide Sedation  Pulse  Bradycardia  Less than 60 BPM  May cause lightheadedness, dizziness, chest pain, syncope, circulatory collapse  Treated with Atropine to increase heart rate  Not something a hygienist will administer  Usually in emergency kits of DDS with training in sedation and general anesthesia (Source: Malamed SF. Medical Emergencies in the Dental Office. 7th Edition)  FYI: Many patients with continued or chronic bradycardia require a pacemaker  Pulse  Assess rhythm and strength  Rhythm – relation of one pulse to another as measured by regularity of action  Irregular pulse could be a sign of arrhythmia  Strength – reflects volume of blood pushing against vessel walls with each contraction (AKA stroke volume)  Bounding pulse can be dangerous in hypertensive patients  Increased risk of CVA  Weak pulse (thready) – decreased stroke volume  Difficult to detect pulse  Pulse  Patients with pulse irregularities should be referred to physician for further assessment  Respiration  Process by which O2 and CO2 exchanged  External respiration  O2 taken IN  CO2 eliminated via LUNGS  Internal respiration  Use of O2  Production of CO2  Exchange between CELLS Respiration  Respiration  Rate  Number of breaths/min (BPM) or respiration / min (RPM)  Rise and fall of chest  Discretely (observed while taking pulse)  Adult normal rate: 12 – 20 RPM  Children normal rate: 18 – 22 RPM  Respiration  Rate  Tachypnea – abnormally fast rate > 20 Often seen in hyperventilation  Bradypnea – slow rate < 12 Often seen in syncope  Respiration  Rate  Apnea – absence of breathing  If continues results in respiratory arrest  Cannot sustain life  Brain requires O2 Hypoxia  O2 deprivation of 3 minutes leads to cell death / brain damage 10 minutes or longer leads to coma or death Taking a respiration rate Taking a pulse rate  Respiration  Rhythm and depth assessment  Should be regular  Expiration twice as long as inspiration  Respiration  Abnormal patterns  Biot’s Respiration– periods of shallow breathing, alternating with apnea  Cheyne-Stokes Respiration – increased rate and depth alternating with apnea  Kussmaul Breathing – increased depth and rate > 20  Often seen in hyperventilation, DKA (Diabetic Ketoacidosis), or renal failure  Respiration  Quality  Should be quiet, automatic, effortless  Abnormalities usually involve effort or noise  Dyspnea – labored breathing, requires excessive effort  Usually require oxygenation  Respiration  Quality  Noises  Stridor – harsh sound on inspiration – crowing  Associated with obstruction  Wheezing – high-pitched sound on expiration or inspiration  Associated with asthma  Sighs – deep inspiration and prolonged expiration  Stress  Aids in expanding small airways  Respiration  Factors affecting respiration  Age  Medications  Stress  Exercise  Altitude  Gender (based on genetics not choice)  Body Position See next slides for further explanation  Respiration  Factors affecting respiration  Age  Lung capacity increases from childhood to adulthood  Lower respiratory rate  As adult ages lungs less elastic – rate increases  Medications  Narcotics decrease respiratory rate  Depress  Sympathomimetics dilate bronchioles, improving respiration  Stimulants  Respiration  Factors affecting respiration  Stress  Increases strength and depth  Exercise  Increases strength and depth  Altitude  Increased altitude – O2 decreases – rate and depth increases  Gender  Men have larger lung capacity, thus decreased rate  Body position  Slumped or stooped – more difficult to exchange O2  Increased rate and depth  Temperature  Measure of heat associated with metabolism of body  Normal 96.4°F - 99.6°F https://health.clevelandclinic.org/body-temperature-what-is-and-isnt-normal/  Normal 35.8°C – 37.5°C Taking a temperature  Temperature  Pyrexia/Fever >98.6°F (37°C)  Can occur with:  Infection  Malignancy (associated with Cancer)  CHF (congestive heart failure)  Trauma  Drugs  Possible:  Convulsions or delirium may occur with extremely high fevers  Refer to MD  Temperature  Hypothermia >95°F (35°C)  Outward signs:  Shivering  Cool skin  Pallor  Etiology:  Illness  Trauma  Malnutrition  Medications  Refer to MD  Blood Pressure  Force exerted against the blood vessel walls  Systolic/diastolic (