Biomedical Engineering Reference
In-Depth Information
Appendix 7.1 Example 1. Vital Signs and PPE Checklist
(Source: Central Arkansas Veterans Healthcare System.) Force.
NAME
DATE
(INSPECT condition of ALL PPE prior to use)
∗
Medical Exclusion INNER SHROUD TUCKED INSIDE
TIME OUT:
PRE POST
BLOOD PRESSURE: HEART RATE:
∗
> []
RESPIRATION: TEMPERATURE: SKIN:
∗
Open sore, large rash or
∗∗
Prior heat stress or
exhaustion
PAPR-COMBINATION CARTRIDGES………PAPR
FLOW CHECKED……………REMOVED SHOES, JEWELRY, ETC……………INNER NITRILE
GLOVES………………………………INNER SUIT………………………………GLOVES & NECK
TAPED………………………………………OUTER SUIT……………………………………BUTYL
HOOD……………………………………GLOVES & NECK TAPED…………………………OUTER
GLOVES………BOOTS………SUIT TAPED
OVER BOOTS………………………
CHECKED BY:
TIME IN
SUIT:
_____________________________
Employee ID#:
∗
Diastolic > 105 70% (220 - Age)
∗
Any
irregular rate or rhythm
∗
>24/min
∗
>995F oral
WEIGHT:
sunburn
HYDRATION:
MENTAL STATUS:
Alert; oriented to time & place; clear speech; normal gait
MEDICAL
HISTORY:
∗
Any meds last 72 hours
∗
Alcohol past
24 hours
∗
New meds Rx/diagnosis last 2 weeks
∗
Pregnant
Symptoms fever, NV, diarrhea, cough in past 72 hours
NOTES: CHECKED BY:
