EMT · Secondary Assessment · 6 min read
Vital Signs, Exam Techniques, Lung Sounds and Perfusion
- Identify the primary vital signs, normal adult reference ranges, and appropriate reassessment schedules for stable and unstable patients.
- Apply physical examination techniques to evaluate respiratory effort, abdominal findings, and breath sounds across lung fields.
- Evaluate cardiovascular stability and peripheral perfusion using pulse characteristics, blood pressure measurements, skin signs, and pupillary responses.
Baseline Vital Signs and Pulse Assessment
Baseline vital signs serve as an essential reference point to monitor trends in a patient's condition over time. By establishing an initial physiological profile, an EMT can determine whether a patient is improving, remaining stable, or deteriorating during care and transport. The primary vital signs assessed by an EMT include pulse, respirations, blood pressure, pupils, skin signs, and oxygen saturation.
Reassessment schedules depend directly on patient stability. Vital signs should be reassessed every fifteen minutes for a stable patient, whereas vital signs should be reassessed every five minutes for an unstable patient. Frequent checks in unstable patients allow emergency responders to identify rapid clinical changes and adjust supportive interventions without delay.
Pulse assessment includes evaluating rate, rhythm, and quality. The recommended anatomical site for pulse checks varies by the patient's age and level of consciousness. In a conscious adult patient, the radial artery is the primary site for initial pulse assessment. In an unresponsive adult or child, the carotid artery is the recommended pulse assessment site. In an infant younger than one year of age, the brachial artery is the primary site for pulse assessment.
For an adult, a normal resting pulse rate ranges between 60 and 100 beats per minute. Tachycardia in an adult is defined as a resting heart rate greater than 100 beats per minute, while bradycardia in an adult is defined as a resting heart rate less than 60 beats per minute. Pulse quality provides insight into circulatory volume and cardiac performance. A weak and rapid pulse is often described as thready and suggests decreased cardiac output or shock. During progressive states of shock, central pulses persist longer than peripheral pulses.
Common mistakes
- Selecting the incorrect pulse site based on age or responsiveness, such as attempting to check a radial pulse in an unresponsive adult or an infant younger than one year of age.
- Treating a narrowing pulse pressure as conclusive evidence of shock instead of considering it alongside other assessment findings.
- Recording both systolic and diastolic blood pressure values when taking a blood pressure by palpation, which can only provide a systolic measurement.
- Trusting pulse oximeter readings without considering physiological factors, overlooking that severe hypoperfusion, hypothermia, and carbon monoxide toxicity produce inaccurate results.
Key points
- Baseline vital signs establish a reference point to monitor trends, requiring reassessment every fifteen minutes for stable patients and every five minutes for unstable patients.
- Pulse assessment evaluates rate, rhythm, and quality; normal adult resting rate is 60 to 100 beats per minute, with sites chosen by age and responsiveness (radial for conscious adults, carotid for unresponsive adults and children, brachial for infants younger than one year).
- Respiratory assessment evaluates rate, rhythm, and depth; normal adult resting rates are 12 to 20 breaths per minute, with depth assessed via chest expansion and labored breathing evaluated separately as increased respiratory effort.
- Auscultation across multiple chest sites compares breath sounds, distinguishing normal vesicular sounds from wheezing, stridor, crackles, rhonchi, or unilateral diminished sounds that may indicate pneumothorax or hemothorax.
- Blood pressure cuff sizing affects readings (too small reads falsely high; too large reads falsely low), auscultation detects Korotkoff sounds, and palpation provides only systolic values.
- Pupil assessment uses PERRL to detect abnormalities such as unequal pupils (TBI, stroke, ocular trauma), pinpoint pupils (opioid intoxication), and dilated nonreactive pupils (severe hypoxia, serious brain injury).
- Perfusion assessment combines skin signs (color, temperature, moisture), capillary refill, and distal pulses, recognizing that cool, pale, diaphoretic skin indicates sympathetic stimulation and hypoperfusion, and central pulses persist longer than peripheral pulses in progressive shock.
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