What are the fundamentals of assessing vital signs?
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 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 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.
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.