1. Breathe
The average normal breathing times of adults are 1 min, 15~2O times, and those of children are 1 min, 2O~25 times. Breathing frequency and depth are important signs.
Inspection method: generally observe the ups and downs of the chest. If the patient's breathing is weak and the fluctuation of the chest is not easy to observe, a piece of paper or a hair can be placed in front of the patient's nostrils. If paper or hair flutters with breathing, you can know the breathing situation. If the note or hair does not move, it means that the patient has stopped breathing.
Dyspnea in critically ill patients is characterized by shallow and fast breathing or deep and slow breathing, flapping nose, cyanosis of mouth and lips and restlessness. Breathing can be increased to more than 28 times in 1 min, or decreased to less than 8 times in 1 min.
Critical and dying patients will have tidal breathing, breathing will increase and decrease periodically, and intermittent breathing will occur. The patient's breathing is short and shallow at first, then gradually accelerates, deepens and strengthens until it reaches a high point, then turns shallow and weak until it stops completely. Generally, apnea lasts about 1~ 1O seconds, and then goes from shallow to deep, and so on.
2. Pulse
Pulse is an index of heart function. The normal pulse rate is 65~85 beats per minute for adults, 8 o ~ 100 beats per minute for children, and 14O beats per minute for newborns.
Examination method: Press the fingertips of index finger, middle finger and ring finger together on radial artery, carotid artery and thigh artery, and observe the pulse frequency, heart rate, heartbeat intensity and uniformity.
The pulse of critically ill patients is weak, the beating is very slow, or the heartbeat is irregular, or even stops. In severe cases, the heart stops beating.
pupil
Pupils are signs of the state of the heart and central nervous system. Under normal conditions, the pupil contour is regular, and its response to light intensity is consistent with reality. Changes in the size of one or both pupils mean that there are organic lesions in the brain.
Inspection method: First gently flip the upper eyelid, observe the pupil, pay attention to the contraction and expansion of the pupil, and then illuminate with a flashlight to check whether it responds to light stimulation.
In critically ill patients, the pupils of both eyes are different in size and circle, and can also be enlarged or reduced, and the pupils are slow to respond to light irradiation. When a person dies, the pupil does not respond to light and becomes larger and fixed.
4. State of consciousness
Healthy people have normal consciousness, respond to sound and physical stimuli, have rosy complexion, bright eyes, clear language and quick thinking.
Examination method: mainly observe the patient's facial expression. When a person faints, call and push him. If there is no response, it means that he has lost consciousness and is seriously ill.
When people are sick, their expressions are cold, they don't want to talk, their words are low, their answers are slow, they are incoherent, their limbs are weak and they don't want to move.
Critically ill patients have pale face, soft muscles, unconsciousness, and no response to external activities such as inquiry and shoving.
5. Paralysis or loss of consciousness
When conscious patients can't move their limbs at will, even if they are stimulated, it is also called "paralysis state". The paralyzed part of the body does not respond to the sensation of stimulation (pain, etc.). ). Patients with local paralysis caused by injury have limited limb movements and have characteristic reflexes at this time. It is very important to realize that paralysis and sensory loss are symptoms of spinal cord injury. Therefore, in order not to aggravate the spinal cord injury, the injured must be fixed before moving.
Examination method: Ask the injured person how their feet and arms feel, and then diagnose whether they are paralyzed. Then, let the injured people move their arms and feet.
Most patients with upper limb paralysis or sensory loss are cervical spinal cord injury; Paralysis or sensory loss of lower limbs is mostly caused by lumbar spinal cord injury; Limbs are limited in use, mostly spinal cord compression; Unilateral paralysis is mostly brain dysfunction caused by stroke or brain injury.
6. Body temperature
Normal people's body temperature is between 36.2-37.2℃, so we can know their health status according to their body temperature.
Inspection method: Hold the top of the thermometer with the mercury head down, shake the thermometer to make the mercury column below 35℃, put the mercury head end under the patient's armpit and take it out after 1O minutes.
37.4~38℃ is low fever, 38~39℃ is moderate fever, above 39℃ is high fever, and below 36℃ is hypothermia. Patients with high fever and hypothermia should go to the hospital as soon as possible.
7. Let the patient stay in bed for several minutes before blood pressure measurement, and take a sitting position or supine position during measurement. Expose the right upper arm, align the sphygmomanometer with the upper arm and the heart, and wrap the sphygmomanometer flat and wrinkle-free on the upper arm after the gas in the cuff is exhausted. The lower edge of the cuff is 3 cm away from the elbow cross. Put the chest radiograph of the stethoscope on the brachial artery, pump in air to make the mercury column rise above the measuring height, and then slightly open the air valve to make the mercury column slowly drop. When there is no sound at the first sound, the millimeter indicated by mercury column is systolic pressure, and when the sound suddenly weakens, the millimeter indicated by mercury column is diastolic pressure. After the measurement, loosen the air valve, tidy up the cuff, and close the mercury tank switch and the box cover. Precautions: ① Patients with strenuous activities should be examined after rest and quiet. ② Patients who observe blood pressure for a long time should have a fixed time, posture, arm and sphygmomanometer. ③ When measuring blood pressure, the air valve should not be opened too fast, so as to avoid errors caused by unclear scale and inaudible sound changes. ④ Some hypertensive patients may have a short period of silence after the onset of systolic pulsation sound, and the systolic blood pressure should be based on the height of mercury column at the beginning of the sound.