Vital signs

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For other uses, see Vital signs (disambiguation).

Vital signs are measures of various physiological statistics, often taken by health professionals, in order to assess the most basic body functions. Vital signs are an essential part of a case presentation. The act of taking vital signs normally entails recording body temperature, pulse rate (or heart rate), blood pressure, and respiratory rate, but may also include other measurements. Vital signs often vary by age.

Primary four[edit]

There are four vital signs which are standard in most medical settings:

  1. Body temperature
  2. Pulse rate (or heart rate)
  3. Blood pressure
  4. Respiratory rate

The equipment needed is a thermometer, a sphygmomanometer, and a watch.

Though a pulse can often be taken by hand, a stethoscope may be required for a patient with a very weak pulse.

Temperature[edit]

Temperature recording gives an indication of core body temperature which is normally tightly controlled (thermoregulation) as it affects the rate of chemical reactions.

Temperature can be recorded in order to establish a baseline for the individual's normal body temperature for the site and measuring conditions. The main reason for checking body temperature is to solicit any signs of systemic infection or inflammation in the presence of a fever (temp > 38.5°C/101.3°F or sustained temp > 38°C/100.4°F), or elevated significantly above the individual's normal temperature. Other causes of elevated temperature include hyperthermia.

Temperature depression (hypothermia) also needs to be evaluated. It is also noteworthy to review the trend of the patient's temperature. A patient with a fever of 38 °C does not necessarily indicate an ominous sign if his previous temperature has been higher. Body temperature is maintained through a balance of the heat produced by the body and the heat lost from the body.

Temperature is commonly considered to be a vital sign most notably in a hospital setting. EMTs (Emergency Medical Technicians), in particular, are taught to measure the vital signs of: respiration, pulse, skin, pupils, and blood pressure as "the 5 vital signs" in a non-hospital setting.[1]

Blood pressure[edit]

The blood pressure is recorded as two readings; a high systolic pressure, which occurs during the maximal contraction of the heart, and the lower diastolic or resting pressure. A normal blood pressure would be 120 being the systolic over 80, the diastolic. Usually the blood pressure is read from the left arm unless there is some damage to the arm. The difference between the systolic and diastolic pressure is called the pulse pressure. The measurement of these pressures is now usually done with an aneroid or electronic sphygmomanometer. The classic measurement device is a mercury sphygmomanometer, using a column of mercury measured off in millimeters. In the United States and UK, the common form is millimeters of mercury, whilst elsewhere SI units of pressure are used. There is no natural 'normal' value for blood pressure, but rather a range of values that on increasing are associated with increased risks. The guideline acceptable reading also takes into account other co-factors for disease. Therefore, elevated blood pressure (hypertension) is variously defined when the systolic number is persistently over 140–160 mmHg. Low blood pressure is hypotension. Blood pressures are also taken at other portions of the extremities. These pressures are called segmental blood pressures and are used to evaluate blockage or arterial occlusion in a limb (see Ankle brachial pressure index).

Pulse[edit]

Main article: Pulse

The pulse is the physical expansion of the artery. Its rate is usually measured either at the wrist or the ankle and is recorded as beats per minute. The pulse commonly taken is from the radial artery at the wrist. Sometimes the pulse cannot be taken at the wrist and is taken at the elbow (brachial artery), at the neck against the carotid artery (carotid pulse), behind the knee (popliteal artery), or in the foot dorsalis pedis or posterior tibial arteries. The pulse rate can also be measured by listening directly to the heartbeat using a stethoscope. The pulse varies with age. A newborn or infant can have a heart rate of about 130–150 beats per minute. A toddler's heart will beat about 100–120 times per minute, an older child's heartbeat is around 60–100 beats per minute, adolescents around 80–100 beats per minute, and adults' pulse rate is anywhere between 50 and 80 beats per minute.

Respiratory rate[edit]

Main article: Respiratory rate

Varies with age, but the normal reference range for an adult is 16–20 breaths/minute (RCP 2012). The value of respiratory rate as an indicator of potential respiratory dysfunction has been investigated but findings suggest it is of limited value. Respiratory rate is clear indicator of acidotic states, as the main function of respiration is removal of CO2 leaving bicarbonate base in circulation.

Additional signs[edit]

While various additional signs have been proposed, none have been officially universally adopted due to the expense in obtaining equipment required to diagnose and the difficulty in training entry-level professionals.

Fifth sign[edit]

The phrase "fifth vital sign" usually refers to pain, as perceived by the patient on a pain scale of 0–10. For example, the Veterans Administration made this their policy in 1999. However, some doctors have noted that pain is actually a subjective symptom, not an objective sign, and therefore object to this classification.[2][unreliable medical source?]

Other sources include oxygen saturation as their fifth sign.[3][4][5]

Some sources consider pupil size, equality, and reactivity to light to be a vital sign as well.[6]

Many EMS agencies in the United States use pulse oximetry and blood glucose level as vital signs in addition to pulse, respiratory rate, and blood pressure.[citation needed]

Sixth sign[edit]

There is no standard "sixth vital sign", and the use is much more informal and discipline-dependent than with the above, but some proposals (excluding the fifth sign candidates above) include:

Seventh sign[edit]

Tumor context of vulnerability[16]

Variations by age[edit]

Reference ranges for blood pressure
Stage Approximate age Systolic Diastolic
Range Typical example Range Typical example
Infants 1 to 12 months 75-100[17] 85 50–70[17] 60
Toddlers 1 to 4 years 80-110[17] 95 50–80[17] 65
Preschoolers 3 to 5 years 80-110[17] 95 50–80[17] 65
School age 6 to 13 years 85-120[17] 100 55–80[17] 65
Adolescents 13 to 18 years 95-140[17] 115 60–90[17] 75

Children and infants have respiratory and heart rates that are faster than those of adults as shown in the following table:

Age Normal heart rate
(beats per minute)
Normal respiratory rate
(breaths per minute)
Range[18] Typical example Range[19] Typical example
Newborn 100–160[20] 130 30–50 40
0–5 months 90–150 120 25–40 30
6–12 months 80–140 110 20–30 25
1–3 years 80–130 105 20–30 25
3–5 years 80–120 100 20–30 25
6–10 years 70–110 90 15–30 20
11–14 years 60–105 80 12–20 16
15–20 years 60–100 80 12–30 20

Monitoring[edit]

An anesthetic machine with integrated systems for monitoring of several vital parameters, including blood pressure and heart rate.

Monitoring of vital parameters most commonly include at least blood pressure and heart rate, and preferably also pulse oximetry and respiratory rate. Multimodal monitors that simultaneously measure and display the relevant vital parameters are commonly integrated into the bedside monitors in critical care units, and the anesthetic machines in operating rooms. These allow for continuous monitoring of a patient, with medical staff being continuously informed of the changes in general condition of a patient.

While monitoring has traditionally been done by doctors, a number of companies are developing devices which can be used by consumers themselves. These include Scanadu and Azoi.

See also[edit]

References[edit]

  1. ^ Emergency Care, 11th edition, pp. 226–244.
  2. ^ Lee HS (November 2004). "Letters to the Editor: Physical Diagnosis 101: A Lesson From the First Year of Medical School". American Society of Anesthesiologists Newsletter 68 (11). Archived from the original on 2004-11-03. 
  3. ^ Mower W, Myers G, Nicklin E, Kearin K, Baraff L, Sachs C (1998). "Pulse oximetry as a fifth vital sign in emergency geriatric assessment". Acad Emerg Med 5 (9): 858–65. doi:10.1111/j.1553-2712.1998.tb02813.x. PMID 9754497. 
  4. ^ Mower W, Sachs C, Nicklin E, Baraff L (1997). "Pulse oximetry as a fifth pediatric vital sign". Pediatrics 99 (5): 681–6. doi:10.1542/peds.99.5.681. PMID 9113944. 
  5. ^ Neff T (1988). "Routine oximetry. A fifth vital sign?". Chest 94 (2): 227. doi:10.1378/chest.94.2.227a. PMID 3396392. 
  6. ^ Dickinson, Edward C.; Limmer, Daniel; O'Keefe, Michael F., ed. (2005). Emergency care (10th ed.). Upper Saddle River, N.J: Pearson/Prentice Hall. pp. 212, 218. ISBN 0-13-114233-X. 
  7. ^ Joseph A (2003). "Continence: the sixth vital sign?". Am J Nurs 103 (7): 11. doi:10.1097/00000446-200307000-00002. PMID 12865635. 
  8. ^ Vardi A, Levin I, Paret G, Barzilay Z (2000). "The sixth vital sign: end-tidal CO2 in pediatric trauma patients during transport". Harefuah 139 (3–4): 85–7, 168. PMID 10979461. 
  9. ^ Bultz B, Carlson L (2006). "Emotional distress: the sixth vital sign—future directions in cancer care". Psychooncology 15 (2): 93–5. doi:10.1002/pon.1022. PMID 16444764. 
  10. ^ http://www.ohsu.edu/medicine/residency/handouts/0405handouts/COPD091304.ppt
  11. ^ "Glycemic Control in the Hospitalized Patient" (Powerpoint). University of Iowa. 
  12. ^ Bierman A (2001). "Functional Status: The Sixth Vital Sign". J Gen Intern Med 16 (11): 785–6. doi:10.1111/j.1525-1497.2001.10918.x. PMC 1495293. PMID 11722694. 
  13. ^ "Nursing care of dyspnea: the 6th vital sign in individuals with chronic obstructive pulmonary disease (COPD).". National Guideline Clearinghouse. 
  14. ^ Studenski S, Perera S, Wallace D, et al (2003). "Physical performance measures in the clinical setting". J Am Geriatr Soc 51 (9): 314–322. doi:10.1046/j.1532-5415.2003.51104.x. PMID 12588574. 
  15. ^ ACOG Committee on Adolescent Health Care. "Menstruation in girls and adolescents: using the menstrual cycle as a vital sign". Obstet Gynecol. 108 (5): 1323–8. doi:10.1097/00006250-200611000-00059. 
  16. ^ Weiss GJ."Overview of Cancer Precision Medicine"Translational Thoracic Oncology Program, Medical University of Vienna, Vienna, Austria, September 2012
  17. ^ a b c d e f g h i j PEDIATRIC AGE SPECIFIC, page 6. Revised 6/10. By Theresa Kirkpatrick and Kateri Tobias. UCLA Health System
  18. ^ Emergency Care, Page 214
  19. ^ Emergency Care, Page 215
  20. ^ Vorvick, Linda. "Pulse". MedlinePlus. U.S. National Library of Medicine. Retrieved 23 January 2011. 

RCP (2012)National Early Warning Score (NEWS)Standardising the assessment of acute-illness severity in the NHS. Royal college of physicians: London

External links[edit]