One of your crew is sick or injured and you are several hours from the nearest port. You contact your medical service provider and the doctor instructs you to get the patient’s baseline vitals and “sample” history.
What are baseline vitals and sample history, and why are they important?
Think of the doctor on the other end of the telephone as a detective trying to solve a mystery. The doctor needs you to provide the clues to help figure out what is wrong with our patient.
The doctor may first instruct you to check the patient’s pulse. The pulse is the beat you feel against the wall of an artery when the heart beats. The pulse is the same as your heart rate. In a normal adult, the pulse will be between 60 and 100 beats per minute. On an adult, you should check either the carotid or radial pulse.
The carotid is the artery in the neck between the windpipe and neck muscle located just under the jaw bone. To check this, place your index and middle finger on the victim’s Adam’s apple, trace over to the side of the neck and press firmly just under the jaw bone until you locate the carotid artery.
The radial pulse is the artery on the inside of the wrist toward the thumb. Again, place your index and middle finger on the wrist and feel for the radial pulse. You should practice this on yourself from time to time. If you are able to feel and count your own pulse then finding and counting the pulse on someone else will be easier.
On a child or infant, check the brachial pulse found on the inside of the upper arm.
Next, the doctor will ask about respirations. Is the person breathing? If so, describe the breathing to the doctor. Does breathing seem normal, fast or slow? What about the quality? Look at the chest rise and fall. Does it appear normal, shallow, labored or noisy? If it’s noisy, describe the noise. Is it snoring, wheezing, gurgling or does it sound harsh (crowing)?
Now look at skin color. Does the skin look normal or is it flushed (red), cyanotic (blue), are they pale, jaundiced (yellow), or mottling (blotchiness)?
And touch the skin. Does it feel hot, cold or normal? Cool and clammy, cold and moist, cold and dry, hot and dry, hot and moist, or goose pimples?
In addition to skin, the doctor will want to know about the eyes. Describe what the pupils look like. Is the pupil size large or small? Are they equal in size? Do they react to light when you shine a small flashlight in their eyes?
Blood pressure is the pressure in the blood due to the beating heart. There are two types of blood pressure: systolic and diastolic. The systolic blood pressure is the maximum pressure when the heart is pushing the blood throughout the body. The diastolic blood pressure is the pressure when the heart is relaxing. Blood pressure is expressed in terms of the systolic pressure and diastolic pressure, for example 120/80, or 120 over 80.
The term blood pressure usually refers to the pressure measured on a person’s upper arm. Blood pressure is measured on the inside of an elbow at the brachial artery, which is the upper arm’s major blood vessel that carries blood away from the heart.
If you have a manual blood pressure cuff and you and your crew are unfamiliar with its operation, I have two suggestions. First, try it out. Try taking each other’s blood pressure. Learn during down time instead of during a medical emergency.
The second suggestion is to get a good electronic blood pressure cuff. These are so simple to use. Plus, you can take your own blood pressure with an electronic cuff, and they often measure the heart rate, or pulse, as well.
Beyond what you see
The phrase sample history is actually an acronym for signs, allergies, medications, pertinent history, last oral intake and events.
Signs/symptoms. This is what’s wrong. What do you see?
Allergies. Is the person allergic to any medications, foods, bees, chemicals or anything that they may have come into contact with? Do they have a medical ID tag?
Medications. What medications did they take? This is everything, including prescription drugs, over-the-counter medications and illegal drugs.
Past pertinent history. This is anything medically relevant about this person, including recent surgery, injury or illness.
Last oral intake. What and when did they eat last?
Events leading to the injury or illness. What did they do just before they began feeling bad?
Being able to quickly provide the patient’s vitals and “sample” history to the doctors will greatly assist them in properly diagnosing and treating your patient. As with many medical emergencies, we can’t waste time. The faster we can deliver quality care the greater our patient’s chances for making a full recovery.
Keith Murray, a former firefighter EMT, owns The CPR School, a first-aid training company. He provides onboard training for yacht captains and crew and sells and services AEDs. Contact him at 877-6-AED-CPR, 877-623-3277 or www.TheCPRSchool.com. Comments on this column are welcome at firstname.lastname@example.org.