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Vital signs

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For other uses, see Vital signs (disambiguation).

Vital signs (often shortened to just vitals) are a group of the 4 to 6 most important 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, gender, 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:

  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. Though 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.

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.[9]

Pulse

Main article: Pulse

The pulse or heart rate is the rate at which the heart beats while pumping blood through the arteries. 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

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.

Blood pressure

Main article: Blood pressure § Measurement

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).

Additional signs

In the U.S., in addition to the above four, it is required to record the patients Height, Weight, and Body Mass Index.[10]

Fifth vital signs

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

  • Pain is considered a standard fifth vital sign in some organizations such as the U.S. Veterans Affairs.[11] Pain is measured on a pain scale based on subjective patient reporting and may be unreliable.[12] Some studies show that recording pain routinely may not change management.[13][14][15] Other "fifth vital signs" include:

Sixth vital signs

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

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[27] 85 50–70[27] 60
Toddlers 1 to 4 years 80-110[27] 95 50–80[27] 65
Preschoolers 3 to 5 years 80-110[27] 95 50–80[27] 65
School age 6 to 13 years 85-120[27] 100 55–80[27] 65
Adolescents 13 to 18 years 95-140[27] 115 60–90[27] 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[28] Typical example Range[29] Typical example
Newborn 100–160[30] 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

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

References

  1. ^ http://my.clevelandclinic.org/healthy_living/prevention/hic_vital_signs.aspx
  2. ^ http://www.emergencycareforyou.org/VitalCareMagazine/ER101/Default.aspx?id=500
  3. ^ http://prohealthsys.com/site/resources/assessment/physical-assessment/vital-signs/vital_signs_table/
  4. ^ https://loinc.org/
  5. ^ https://loinc.org/news/loinc-a-lingua-franca-critical-for-electronic-medical-records-and-health-information-exchange.html/?searchterm=blood%20pressure
  6. ^ 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. ^ Emergency Care, 11th edition, pp. 226–244.
  10. ^ http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/record-vital-signs
  11. ^ http://www.va.gov/painmanagement/docs/toolkit.pdf
  12. ^ http://www.jabfm.org/content/22/3/291.full
  13. ^ http://www.aafp.org/afp/2006/1015/p1417a.html
  14. ^ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924634/
  15. ^ http://www.pain-initiative-un.org/doc-center/en/docs/The%20Fifth%20Vital%20Sign%20Implementation.pdf
  16. ^ 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.
  17. ^ 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)
  18. ^ a b http://www.ncbi.nlm.nih.gov/pubmed/16374268
  19. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  21. ^ Neff T (1988). "Routine oximetry. A fifth vital sign?". Chest. 94 (2): 227. doi:10.1378/chest.94.2.227a. PMID 3396392.
  22. ^ "Glycemic Control in the Hospitalized Patient" (Powerpoint). University of Iowa.
  23. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  24. ^ 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.
  25. ^ "Nursing care of dyspnea: the 6th vital sign in individuals with chronic obstructive pulmonary disease (COPD)". National Guideline Clearinghouse.
  26. ^ 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.
  27. ^ 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
  28. ^ Emergency Care, Page 214
  29. ^ Emergency Care, Page 215
  30. ^ Vorvick, Linda. "Pulse". MedlinePlus. U.S. National Library of Medicine. Retrieved 23 January 2011.
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