Unit 3: Secondary Assessment
Vital Signs & Patient Reassessment
A patient’s vital signs can reveal important clues about their medical condition, but a single set of readings tells only part of the story. EMTs must know how to measure vital signs, recognize abnormal findings, and identify changes that may indicate a worsening emergency. This NREMT study guide lesson covers vital signs, patient reassessment, and monitoring the effectiveness of treatment. Five EMT practice questions will help you review these essential assessment skills.
Vital signs provide objective information about how well a patient’s body is functioning. EMTs obtain baseline measurements and compare them with later readings to determine whether the patient’s condition is improving, remaining stable, or deteriorating.
Patient reassessment is an ongoing process that begins after the initial assessment and continues throughout treatment and transport.
Measuring Vital Signs
The primary vital signs assessed by EMTs include pulse, respiratory rate, blood pressure, and temperature. Oxygen saturation, pain, and blood glucose may also be assessed when appropriate.
Pulse
The pulse provides information about heart rate, rhythm, and circulation.
A normal resting adult pulse is generally 60–100 beats per minute (BPM).
When assessing a pulse, determine:
- Rate: How many times the heart beats per minute.
- Rhythm: Whether the pulse is regular or irregular.
- Quality: Whether the pulse feels strong, weak, or thready.
A rapid, weak pulse may indicate poor circulation or shock.
Respiratory Rate
Respiratory rate is the number of breaths taken per minute.
A normal resting adult respiratory rate is approximately 12–20 breaths per minute.
In addition to counting respirations, assess breathing depth, rhythm, and effort.
Rapid, shallow, or irregular breathing may indicate a serious respiratory or circulatory problem.
Blood Pressure
Blood pressure measures the force of blood against artery walls.
It is recorded using two numbers:
- Systolic pressure: The pressure when the heart contracts.
- Diastolic pressure: The pressure when the heart relaxes between beats.
For example, a blood pressure of 120/80 mmHg indicates a systolic pressure of 120 and a diastolic pressure of 80.
Blood pressure must be interpreted alongside the patient’s symptoms and other vital signs.
A falling blood pressure may indicate worsening shock or another serious medical condition.
Body Temperature
Body temperature helps identify conditions such as fever, hypothermia, and heat-related illness.
Average normal body temperature is approximately 98.6°F (37°C), although normal readings vary.
Both abnormally high and low temperatures may indicate medical emergencies.
Other Important Measurements
EMTs may obtain additional measurements based on the patient’s symptoms and local protocols.
Pulse Oximetry
A pulse oximeter estimates the percentage of hemoglobin carrying oxygen in the blood, reported as SpO₂.
For most healthy adults at sea level, normal oxygen saturation is approximately 95–100%.
Pulse oximetry is useful for monitoring oxygenation, but readings may be inaccurate because of poor circulation, patient movement, or other factors.
Always interpret SpO₂ alongside the patient’s clinical condition.
Blood Glucose
Blood glucose testing measures the amount of sugar in the bloodstream.
It may be particularly useful when assessing patients with diabetes, altered mental status, seizures, or unexplained weakness.
A blood glucose level below 70 mg/dL generally indicates hypoglycemia.
Follow local protocols when performing blood glucose testing and treating abnormal results.
Pain Assessment
Pain can be assessed using a numerical scale from 0 to 10:
- 0: No pain.
- 1–3: Mild pain.
- 4–6: Moderate pain.
- 7–10: Severe pain.
Pain scores help EMTs monitor symptoms and determine whether treatment has been effective. Pain is subjective, so the patient’s description is important.
Understanding Normal and Abnormal Findings
Normal vital signs vary with age, activity level, medical history, and other factors.
For example, infants and young children generally have faster heart rates and respiratory rates than adults.
A physically active adult may also have a resting pulse below 60 BPM without having a medical emergency.
EMTs should avoid interpreting measurements in isolation.
For example, a patient with a rapid pulse, cool skin, and increasing confusion may be experiencing shock even if their blood pressure remains within the normal range.
Always consider the complete clinical picture.
Baseline Vital Signs
The first complete set of vital signs obtained during patient care is known as the baseline vital signs.
These measurements establish a reference point for evaluating changes in the patient’s condition.
For example:
A patient initially has a pulse of 96 BPM and a blood pressure of 118/76 mmHg.
Ten minutes later, the pulse increases to 124 BPM and the blood pressure decreases to 92/60 mmHg.
This change may indicate worsening circulation and requires immediate reassessment.
Record the time each set of vital signs was obtained so that changes can be accurately documented.
Patient Reassessment
Reassessment involves repeating important portions of the patient assessment to identify changes and evaluate the effectiveness of treatment.
A reassessment should include:
- Reevaluate the patient’s level of consciousness.
- Recheck airway, breathing, and circulation.
- Obtain another set of vital signs.
- Reassess the patient’s chief complaint or injuries.
- Evaluate the effectiveness of treatments already provided.
For example, after administering oxygen to a patient with difficulty breathing, reassess their breathing effort, mental status, and oxygen saturation.
If the patient is deteriorating, provide appropriate interventions, reconsider transport priority, and notify the receiving hospital when necessary.
Reassessment Intervals
The patient’s condition helps determine how frequently reassessment should occur.
| Patient Condition | Recommended Reassessment Interval |
| Unstable patient | At least every 5 minutes |
| Stable patient | Approximately every 15 minutes |
Unstable patients include those with significant breathing problems, shock, altered mental status, or other potentially life-threatening conditions.
Stable patients have no immediate life threats and are not showing signs of significant deterioration.
These intervals are general EMT guidelines. Reassess more frequently whenever the patient’s condition requires it, particularly after treatment or a sudden change in symptoms.
Do not wait for the next scheduled reassessment if a patient develops a new problem.
Recognizing Changes in Patient Condition
Repeated assessment helps EMTs identify whether a patient’s condition is improving or worsening.
Signs of improvement may include:
- More effective breathing.
- Improving mental status.
- Stronger peripheral pulses.
- Stabilizing vital signs.
- Reduced pain or other symptoms.
Signs of deterioration may include:
- Increasing respiratory distress.
- Decreasing level of consciousness.
- Weakening pulses.
- Falling blood pressure.
- Increasing heart rate.
- New or worsening symptoms.
When a significant change occurs, repeat the primary assessment, address immediate life threats, and adjust treatment according to EMS protocols.
Documenting Reassessment Findings
Accurate documentation helps the receiving medical team understand the patient’s condition and response to care.
Record:
- Each set of vital signs and the time obtained.
- Changes in the patient’s level of consciousness.
- Changes in symptoms or physical findings.
- Treatments provided.
- The patient’s response to those treatments.
For example, documenting that a patient’s respiratory rate decreased from 32 to 20 breaths per minute after treatment provides more useful information than simply recording that the patient "improved."
Key Tip
Pay attention to trends, not just individual numbers. A patient whose pulse is increasing, blood pressure is falling, and mental status is worsening may be developing shock. Reassess unstable patients at least every five minutes, and always repeat the assessment when their condition changes.