ASK DAN

What are the fun­da­men­tals of as­sess­ing vi­tal signs?

Scuba Diving - - TRAIN - BY DIVERS ALERT NETWORK

You’ll rarely get a warn­ing be­fore wit­ness­ing a med­i­cal emer­gency, and no mat­ter what level of diver you are, it’s your re­spon­si­bil­ity to know how to re­spond to an emer­gency at a dive site. Be­ing trained and will­ing to help an in­jured diver or by­stander can make an enor­mous dif­fer­ence in the out­come of their in­juries, and even save lives. The abil­ity to as­sess vi­tal signs is fun­da­men­tal in firstaid train­ing. Ac­cu­rate measurements of vi­tal signs can not only pro­vide EMS per­son­nel with valu­able in­for­ma­tion about the pa­tient’s con­di­tion, but can also ex­pe­dite needed med­i­cal in­ter­ven­tions and pro­vide a time­line of in­jury pro­gres­sion for health­care providers. How well do you know how to as­sess ba­sic vi­tal signs?

TIME

Time is the fun­da­men­tal met­ric in all emer­gency re­sponses. Reg­u­larly record­ing the pa­tient’s con­di­tion and the cor­re­spond­ing time is vi­tal to cre­at­ing an ac­cu­rate time­line of pa­tient symp­toms. These time­lines can be used to de­ter­mine whether a pa­tient’s con­di­tion is wors­en­ing and help eval­u­ate the need for greater care. Se­ri­ously ill pa­tients should have their vi­tal signs re­assessed ev­ery few min­utes, while pa­tients who are sta­ble may have their vi­tals checked hourly.

LEVEL OF RE­SPON­SIVE­NESS

A pa­tient’s level of re­spon­sive­ness ( LOR) can be one of the most re­veal­ing in­di­ca­tors of their well-be­ing.

LOR is typ­i­cally as­sessed with four ba­sic ques­tions: What is your name? Where are we? What time is it? What hap­pened? If an in­di­vid­ual can an­swer all of these ques­tions with rea­son­able ac­cu­racy, you can list their LOR as “alert and ori­ented to per­son, place, time, and event,” which is fre­quently abbreviated to “A+ Ox4.” If a per­son is un­con­scious, or can­not oth­er­wise re­spond to these ques­tions, you can fur­ther as­sess their LOR by de­ter­min­ing if they are re­spon­sive to ver­bal or painful stim­uli. A com­mon scale used to de­scribe a per­son’s men­tal sta­tus is the AVPU scale. AVPU is an acro­nym that stands for “alert, ver­bal, painful, un­re­spon­sive.”

An in­di­vid­ual who re­sponds to your ini­tial ques­tions can be con­sid­ered awake, and given an “A” on the AVPU scale. If the per­son does not re­spond to com­mands but re­acts to you rais­ing your voice, they’d be given a “V” for ver­bal stim­u­la­tion. Re­sponse to a firm rub on the back of the hand or a pinch on the up­per arm would de­note a “P,” and a com­plete lack of re­sponse would de­note a “U” for un­re­spon­sive. Note that while this sys­tem of quan­ti­fy­ing re­spon­sive­ness might pro­vide use­ful in­for­ma­tion to health­care per­son­nel, it is not likely to change the care that we as divers will pro­vide — a con­fused or non­re­spon­sive pa­tient should al­ways be treated as if they were se­ri­ously in­jured.

PULSE

Pulse can be a very ef­fec­tive in­di­ca­tion of an in­di­vid­ual’s well­ness, es­pe­cially if more than just the fre­quency of heart beats is mea­sured. As­sess a pulse by plac­ing two fin­gers gen­tly on ei­ther the carotid artery (found lat­eral to the tra­chea), or on a pa­tient’s wrist just be­neath the base of their thumb (this is a ra­dial pulse).

If you can­not find a pulse, first con­firm the lo­ca­tion of your fin­gers, then make sure you are not press­ing too hard or too gen­tly. Once you lo­cate a pulse, count the num­ber of beats in 15 sec­onds, then mul­ti­ply by four — this will give you the

As­sess a pulse by plac­ing two fin­gers gen­tly on ei­ther the carotid artery (found lat­eral to the tra­chea), or on a pa­tient’s wrist just be­neath the base of their thumb.

diver’s heart rate in beats per minute. Most healthy adults have a rest­ing heart rate of be­tween 60 and 100 beats per minute, although an el­e­vated heart rate af­ter in­jury, ex­er­cise or ex­cite­ment is nor­mal. Note not just the speed at which the heart beats but also the strength and reg­u­lar­ity of the beat; these can be im­por­tant fac­tors in de­ter­min­ing in­jury sever­ity.

RES­PI­RA­TION

A body can­not sur­vive for more than a few min­utes with­out oxy­gen, and you must con­stantly mon­i­tor an in­jured diver’s res­pi­ra­tions. Be­cause many peo­ple will un­in­ten­tion­ally al­ter their breath­ing if they know you are try­ing to count their breaths, be­gin count­ing res­pi­ra­tions im­me­di­ately af­ter mea­sur­ing a pa­tient’s pulse and with­out an­nounc­ing it.

Pay close at­ten­tion to the sound of the per­son’s breath­ing and lis­ten for wheez­ing, gasp­ing or la­bored breaths. These can in­di­cate the ex­is­tence of spe­cific con­di­tions such as asthma or pul­monary edema.

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