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Vital signs

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For other uses, see Vital signs (disambiguation).
Vital signs
An anesthetic machine with integrated systems for monitoring of several vital parameters, including blood pressure and heart rate
Purposeassess the general physical health of a person

Vital signs (also known as vitals) are a group of the four to six most crucial medical signs that indicate the status of the body's vital (life-sustaining) functions. These measurements are taken to help assess the general physical health of a person, give clues to possible diseases, and show progress toward recovery.[1][2] The normal ranges for a person's vital signs vary with age, weight, sex, and overall health.[3]

There are four primary vital signs: body temperature, blood pressure, pulse (heart rate), and breathing rate (respiratory rate), often notated as BT, BP, HR, and RR. However, depending on the clinical setting, the vital signs may include other measurements called the "fifth vital sign" or "sixth vital sign". Vital signs are recorded using the LOINC internationally accepted standard coding system.[4][5]

Early warning scores have been proposed that combine the individual values of vital signs into a single score. This was done in recognition that deteriorating vital signs often precede cardiac arrest and/or admission to the intensive care unit. Used appropriately, a rapid response team can assess and treat a deteriorating patient and prevent adverse outcomes.[6][7][8]

Primary vital signs

There are four primary vital signs which are standard in most medical settings:[9]

  1. Body temperature
  2. Heart rate or Pulse
  3. Respiratory rate
  4. Blood pressure

The equipment needed is a thermometer, a sphygmomanometer, and a watch. Although a pulse can be taken by hand, a stethoscope may be required for a patient with a very weak pulse.

Temperature

Temperature recording gives an indication of core body temperature which is normally tightly controlled (thermoregulation) as it affects the rate of chemical reactions. Body temperature is maintained through a balance of the heat produced by the body and the heat lost from the body.

Oral glass thermometer showing a body temperature in °F

Temperature can be recorded in order to establish a baseline for the individual's normal body temperature for the site and measuring conditions.

Temperature can be measured from the mouth, rectum, axilla (armpit), ear, or skin. Oral, rectal, and axillary temperature can be measured with either a glass or electronic thermometer.[10] Note that rectal temperature measures approximately 0.5 °C higher than oral temperature, and axillary temperature approximately 0.5 °C less than oral temperature.[11] Aural and skin temperature measurements require special devices designed to measure temperature from these locations.[10]

While 37 °C (98.6 °F) is considered "normal" body temperature, there is some variance between individuals. Most have a normal body temperature set point that falls within the range of 36.0 °C to 37.5 °C (96.5–99.5 °F).[12]

The main reason for checking body temperature is to solicit any signs of systemic infection or inflammation in the presence of a fever. Fever is considered temperature of 37.8 °C or above.[12] Other causes of elevated temperature include hyperthermia, which results from unregulated heat generation or abnormalities in the body's heat exchange mechanisms.[12]

Temperature depression (hypothermia) also needs to be evaluated. Hypothermia is classified as temperature below 35 °C (95 °F).[11]

It is also recommended to review the trend of the patient's temperature over time. A fever of 38 °C does not necessarily indicate an ominous sign if the patient's previous temperature has been higher.

Pulse

Main article: Pulse
An individual taking their own radial pulse.

The pulse is the rate at which the heart beats while pumping blood through the arteries, recorded as beats per minute (bpm).[10] It may also be called "heart rate". In addition to providing the heart rate, the pulse should also be evaluated for strength and obvious rhythm abnormalities.[10] The pulse is commonly taken at the wrist (radial artery). Alternative sites include the elbow (brachial artery), the neck (carotid artery), behind the knee (popliteal artery), or in the foot (dorsalis pedis or posterior tibial arteries).[10] The pulse is taken with the index finger and middle finger by pushing with firm yet gentle pressure at the locations described above, and counting the beats felt per 60 seconds (or per 30 seconds and multiplying by two).[10] The pulse rate can also be measured by listening directly to the heartbeat using a stethoscope. The pulse may vary due to exercise, fitness level, disease, emotions, and medications.[10] The pulse also varies with age. A newborn can have a heart rate of 100–⁠160 bpm, an infant (0–⁠5 months old) a heart rate of 90–⁠150 bpm, and a toddler (6–⁠12 months old) a heart rate of 80–140 bpm.[11] A child aged 1–⁠3 years old can have a heart rate of 80–⁠130 bpm, a child aged 3–⁠5 years old a heart rate of 80–⁠120 bpm, an older child (age of 6–10) a heart rate of 70–⁠110 bpm, and an adolescent (age 11–⁠14) a heart rate of 60–105 bpm.[11] An adult (age 15+) can have a heart rate of 60–100 bpm.[13]

Respiratory rate

Main article: Respiratory rate

Average respiratory rates vary between ages, but the normal reference range for people age 18 to 65 is 16–20 breaths per minute.[6] 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 a clear indicator of acidotic states, as the main function of respiration is removal of CO2 leaving bicarbonate base in circulation.

Blood pressure

Main article: Blood pressure § Measurement
Manual sphygmomanometer and stethoscope used to take blood pressure in clinic.

Blood pressure is recorded as two readings: a higher systolic pressure, which occurs during the maximal contraction of the heart, and the lower diastolic or resting pressure.[10] In adults, a normal blood pressure is 120/80, with 120 being the systolic and 80 being the diastolic reading.[11] 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, while 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).

Other signs

In the U.S., in addition to the above four, many providers are required or encouraged by government technology-in-medicine laws to record the patient's height, weight, and body mass index.[14] In contrast to the traditional vital signs, these measurements are not useful for assessing acute changes in state because of the rate at which they change; however, they are useful for assessing the impact of prolonged illness or chronic health problems.

The definition of vital signs may also vary with the setting of the assessment. Emergency medical technicians (EMTs), 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.[15]

Fifth vital signs

The "fifth vital sign" may refer to a few different parameters.

Sixth vital signs

There is no standard "sixth vital sign"; its use is more informal and discipline-dependent.

Variations by age

Reference ranges for blood pressure
Stage Approximate age Systolic Diastolic
Range Typical example Range Typical example
Infants 1 to 12 months 75-100[33] 85 50–70[33] 60
Toddlers 1 to 4 years 80-110[33] 95 50–80[33] 65
Preschoolers 3 to 5 years 80-110[33] 95 50–80[33] 65
School age 6 to 13 years 85-120[33] 100 55–80[33] 65
Adolescents 13 to 18 years 95-140[33] 115 60–90[33] 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[34] Typical example Range[35] Typical example
Newborn 100–160[36] 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[37] 20

Monitoring

Monitoring of vital parameters most commonly includes 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 intensive 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 the general condition of a patient.

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

See also

References

  1. ^ "Vital Signs".
  2. ^ "Emergency Physicians Home". www.emergencyphysicians.org.
  3. ^ "Vital Signs Table - ProHealthSys". 3 July 2013.
  4. ^ "Home". LOINC.
  5. ^ "LOINC - A Lingua Franca Critical for Electronic Medical Records and Health Information Exchange". Archived from the original on 2016-03-08. Retrieved 2014-08-24.
  6. ^ a b National Early Warning Score Development and Implementation Group (NEWSDIG) (2012). National Early Warning Score (NEWS): standardising the assessment of acute-illness severity in the NHS. London: Royal College of Physicians. ISBN 978-1-86016-471-2.
  7. ^ National Institute for Health and Clinical Excellence. Clinical guideline 50: Acutely ill patients in hospital. London, 2007.
  8. ^ "Acute care toolkit 6: the medical patient at risk: recognition and care of the seriously ill or deteriorating medical patient" (PDF). Royal College of Physicians of London. May 2013.
  9. ^ "Vital Signs". Cleveland Clinic. Retrieved 10 Sep 2020.
  10. ^ a b c d e f g h "Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)". www.hopkinsmedicine.org. Retrieved 2019-08-30.
  11. ^ a b c d e "Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate". 2019-07-23. {{cite journal}}: Cite journal requires |journal= (help)
  12. ^ a b c LeBlond, Richard F.; Brown, Donald D.; Suneja, Manish; Szot, Joseph F. (2014-09-05). DeGowin's diagnostic examination (10th ed.). New York: McGraw-Hill Education. ISBN 9780071814478. OCLC 876336892.
  13. ^ "Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate". 2019-07-23. {{cite journal}}: Cite journal requires |journal= (help) [verification needed]
  14. ^ "What should I include when I record vital signs of my patients for MU? - Providers & Professionals - HealthIT.gov".
  15. ^ Emergency Care, 11th edition, pp. 226–244.
  16. ^ http://www.va.gov/painmanagement/docs/toolkit.pdf [bare URL PDF]
  17. ^ Lorenz, Karl A.; Sherbourne, Cathy D.; Shugarman, Lisa R.; Rubenstein, Lisa V.; Wen, Li; Cohen, Angela; Goebel, Joy R.; Hagenmeier, Emily; Simon, Barbara; Lanto, Andy; Asch, Steven M. (1 May 2009). "How Reliable is Pain as the Fifth Vital Sign?". J Am Board Fam Med. 22 (3): 291–298. doi:10.3122/jabfm.2009.03.080162. PMID 19429735.
  18. ^ Wellbery, Caroline (15 October 2006). "Tips From Other Journals - American Family Physician". American Family Physician. 74 (8): 1417–1418.
  19. ^ Mularski RA, White-Chu F, Overbay D, Miller L, Asch SM, Ganzini L (2006). "Measuring pain as the 5th vital sign does not improve quality of pain management". J Gen Intern Med. 21 (6): 607–12. doi:10.1111/j.1525-1497.2006.00415.x. PMC 1924634. PMID 16808744.
  20. ^ http://www.pain-initiative-un.org/doc-center/en/docs/The%20Fifth%20Vital%20Sign%20Implementation.pdf [bare URL PDF]
  21. ^ American College of Obstetricians and Gynecologists. (2015). "Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Committee Opinion No. 651". Obstet Gynecol. 126: 143–6.
  22. ^ American Academy of Pediatrics, Committee on Adolescence, American College of Obstetricians and Gynecologists, Committee on Adolescent Health Care. (2006). "Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign". Pediatrics. 118 (5).{{cite journal}}: CS1 maint: multiple names: authors list (link)
  23. ^ 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.
  24. ^ Mower W, Sachs C, Nicklin E, Baraff L (1997). "Pulse oximetry as a fifth pediatric vital sign". Pediatrics. 99 (5): 681–6. CiteSeerX 10.1.1.575.2200. doi:10.1542/peds.99.5.681. PMID 9113944.
  25. ^ Neff T (1988). "Routine oximetry. A fifth vital sign?". Chest. 94 (2): 227. doi:10.1378/chest.94.2.227a. PMID 3396392.
  26. ^ "Mining Vital Signs from Wearable Healthcare Device via Nonlinear Machine Learning". University of Hull. Archived from the original on 2016-08-17. Retrieved 2016-05-14.
  27. ^ 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.
  28. ^ Holcomb JB, Salinas J, McManus JM, Miller CC, Cooke WH, Convertino VA (2005). "Manual vital signs reliably predict need for life-saving interventions in trauma patients". J Trauma. 59 (4): 821–8, discussion 828–9. doi:10.1097/01.ta.0000188125.44129.7c. PMID 16374268.
  29. ^ 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.
  30. ^ "Nursing care of dyspnea: the 6th vital sign in individuals with chronic obstructive pulmonary disease (COPD)". National Guideline Clearinghouse. Archived from the original on 2009-01-17. Retrieved 2009-01-16.
  31. ^ Studenski S, Perera S, Wallace D, et al. (2003). "Physical performance measures in the clinical setting" (PDF). J Am Geriatr Soc. 51 (9): 314–322. doi:10.1046/j.1532-5415.2003.51104.x. PMID 12588574. S2CID 31083716.
  32. ^ Bellelli, Giuseppe; Trabucchi, Marco (May 1, 2008). "Delirium as the Sixth Vital Sign". Journal of the American Medical Directors Association. 9 (4): 279, author reply 279–80. doi:10.1016/j.jamda.2007.08.014. PMID 18457806 – via www.jamda.com.
  33. ^ a b c d e f g h i j PEDIATRIC AGE SPECIFIC Archived 2017-05-16 at the Wayback Machine, page 6. Revised 6/10. By Theresa Kirkpatrick and Kateri Tobias. UCLA Health System
  34. ^ Emergency Care, Page 214
  35. ^ Emergency Care, Page 215
  36. ^ Vorvick, Linda. "Pulse". MedlinePlus. U.S. National Library of Medicine. Retrieved 23 January 2011.
  37. ^ "Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate". 2019-07-23. {{cite journal}}: Cite journal requires |journal= (help)
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