Join me on a journey through the vital sign assessment techniques that that I teach in our HLTAID015 Provide Advanced Resuscitation and Oxygen Therapy Course at My First Aid Course Brisbane. This blog will feature a series of articles breaking down the components of this course, written in a user friendly fashion – the same way I deliver training.
In this post, we’ll explore advanced methods for assessing vital signs in the field, with or without specialised equipment. We’ll cover pulse assessment, consciousness levels, respiration, temperature, and visual cues that can guide your actions in critical situations. I’ve deliberately left measuring blood pressure out, as a sphygmomanometer (fancy medical word for BP monitor) isn’t usually readily available in an emergency first aid situation or part of a first aid kit. So, let’s roll up our sleeves and have a go at expanding your first aid toolkit.
Pulse Assessment: The Beat Goes On
One of the most fundamental skills in vital sign assessment is checking a pulse. It seems simple, but there’s more to it than you might think.
Manual Pulse-Taking: The traditional method involves using your index and middle fingers to feel for a pulse, typically at the wrist (radial artery) or neck (carotid artery). When checking the carotid pulse, remember to only check one side at a time to avoid restricting blood flow to the brain.
What are we looking for? Rate, rhythm, and strength. A normal adult pulse rate is somewhere between 60-80 beats per minute. Being mindful that a top-rate athlete may have a regular pulse of 40-50 bpm. The rhythm should be regular, and the strength should be easily palpable. Weak, thready pulses can indicate shock, while a bounding pulse might suggest high blood pressure or anxiety.
Using a Pulse Oximeter: In recent years, pulse oximeters have become more common in first aid kits. These nifty devices clip onto a finger and use light to measure both pulse rate and blood oxygen saturation. They’re particularly useful for performing a vital sign assessment on patients with respiratory issues.
I’ve written a separate article about these devices and go into more detail about how to interpret the data you get from them, here.
When using a pulse oximeter, you’re looking for two numbers:
- Pulse rate (should match what you manually counted)
- Oxygen saturation (SpO2) – normally 95% or higher
Remember, pulse oximeters can be affected by factors like nail polish, poor circulation, or movement. Always correlate the readings with your manual assessment and the patient’s overall condition.
Whichever method you use, practice is key. The more pulses you feel, the better you’ll become at quickly assessing what’s normal and what’s not.
Level of Consciousness: Are You With Me?
Assessing a patient’s level of consciousness (LOC) is significant in determining the severity of their condition and guiding your actions. Two main tools for this may be used: AVPU and the Glascow Coma Scale (GCS).
AVPU Scale: This quick and simple assessment is perfect for initial evaluations and as a tool for advanced first aiders.
A – Alert: The patient is fully awake and responsive.Â
V – Voice responsive: The patient responds to verbal stimuli.Â
P – Pain responsive: The patient only responds to painful stimuli.Â
U – Unresponsive: The patient doesn’t respond to any stimuli.
To test this, start by speaking to the patient. If they don’t respond, give a gentle shake (if it’s safe to do so). If there’s still no response, you can apply a painful stimulus, such as pinching their earlobe or squeezing the shoulder muscles (trapezium).
In medical terms gaining a response is voice or pain doesn’t mean the patient sits up and starts having a long chat with us when we pinch their earlobe. It may be that they merely groan or move their head a little. This is still a response to the stimuli.
GCS: While AVPU is great for quick vital sign assessments, the GCS provides a more detailed evaluation. It’s commonly used by healthcare professionals and scores patients based on eye opening, verbal response, and motor response. The maximum score is 15 (fully alert), and the minimum is 3 (deep coma or death).
As a first aider, you don’t need to memorise the GCS, but it’s good to know it exists and that a score of 8 or less indicates severe impairment requiring immediate medical attention.
Respiration: Every Breath You Take
When doing a vital sign assessment its important to check respiration. Assessing breathing is about more than just checking if someone’s chest is moving. We want to evaluate both the rate and the effort of breathing.
Counting Respiration Rate: To count respirations, watch the rise and fall of the chest for a full minute. (If you’re really under the pump, 30 seconds will suffice. Then double the number). Normal adult respiration rates are between 12-20 breaths per minute. Rates outside this range can indicate distress.
Observing Breathing Effort: Look for signs of increased effort:
- Use of accessory muscles (neck or abdominal muscles visibly working to breathe)
- Nasal flaring
- See-saw breathing (chest goes in when abdomen goes out, or vice versa)
- Inability to speak in full sentences
Signs of respiratory distress include:
- Bluish tinge to lips or fingertips (cyanosis)
- Gasping
- Anxiety or restlessness
- Altered mental state
Temperature: Feeling Hot, Hot, Hot (or Not)
While we’d love to have a thermometer handy at all times, that’s not always the case in an emergency situation. Here’s how to assess temperature without equipment:
Touch Method: Place the back of your hand on the patient’s forehead. Compare it to your own forehead or that of another healthy person if available. This method isn’t precise but can give you a general idea if someone is significantly warmer or cooler than normal.
Signs of Hyperthermia (Too Hot):
- Flushed, hot, dry skin
- Headache, dizziness
- Nausea or vomiting
- Rapid breathing and heart rate
- Altered mental state
Signs of Hypothermia (Too Cold):
- Pale, cool, dry skin
- Shivering (which may stop in severe cases)
- Slurred speech
- Slow, shallow breathing
- Weak pulse
- Confusion or sleepiness
While these methods can give you a general idea, they’re not a substitute for a proper thermometer.
The Eyes: A visual vital sign assessment
Your powers of observation are one of your most valuable tools when performing a vital sign assessment. A quick visual survey can reveal a wealth of information about a patient’s condition.
Skin Colour:
- Pale or ashen: Could indicate shock or poor circulation
- Bluish (cyanosis): Suggests lack of oxygen
- Yellow: Might indicate liver problems
- Cherry red: Possible carbon monoxide poisoning
Other Visual Cues:
- Sweating: Could indicate pain, shock, or heat exhaustion
- Bleeding: Look for visible wounds or blood-soaked clothing
- Swelling: Might suggest injury or allergic reaction
- Pupil size and reactivity: Unequal or unreactive pupils can indicate head injury
As well as performing a vital sign assessment always perform a head-to-toe survey, looking for anything unusual. Trust your instincts – if something doesn’t look right, it probably isn’t.
Putting It All Together: The Primary Survey
Now that we’ve covered these vital sign assessment techniques, let’s see how they fit into the primary survey. In Australia, we use the DRSABCD approach:
D – Danger: Ensure the scene is safe R – Response: Check for response (using AVPU) S – Send for help: Call 000 if needed A – Airway: Check the airway is clear B – Breathing: Look, listen, and feel for breathing C – CPR: Start CPR if necessary D – Defibrillation: Use an AED if available
As you work through these steps, you’ll incorporate the vital sign assessment techniques we’ve discussed. For example, when checking for a response, you’ll use AVPU. When assessing breathing, you’ll count the rate and observe the effort. Your visual assessment will be ongoing throughout the process.
Vital Sign Assessment needs in Person Skills.
Now, I can’t stress this enough: reading about these techniques is no substitute for hands-on training. Skills decay over time, and guidelines change. It’s vital to keep your skills sharp and stay up to date with the latest recommendations.
That’s where the courses offered by My First Aid Course, Brisbane come in. Our courses are designed to give you the confidence and competence to act effectively in emergencies especially when performing a vital sign assessment.
And let me tell you, it’s so important to keep refreshing your skills. Even as a registered nurse, with 30+ years of experience, I make sure to update skills regularly. You never know when these skills might be needed, and when that moment comes, you’ll be glad you put in the effort to stay current.
Ready, Set, Save: Your First Aid Journey Continues
Advanced resusc can seem daunting at first, but with proper training and practice, they become second nature. Remember, the goal is to be prepared, not perfect. Every bit of knowledge and skill you gain increases your ability to help in an emergency.
So, why not take the next step? Sign up for a course, practice your skills, and be ready to make a difference when it matters most. After all, the life you save could be that of a loved one. Stay safe out there!
