Transcript Vital Signs are…Vital!

“Vital Signs are…Vital!”
Jennifer Lyon, M.S., M.L.I.S.
[email protected]
If you remember nothing else…
Vital signs are called ‘vital’ signs
because they are important
 They provide fundamental information on
the general state of health
 Abnormal vital signs must be identified
and resolved or treated

Sample Clinical Questions

How does the literature describe the use of oral
midodrine for treatment of hypotension in patients with
spinal cord injury?
 Should tachycardia patients be pretreated with IV
calcium prior to calcium channel blocker therapy to
avoid hypotension?
 What does the last five years of the literature say
about insulin's role in postprandial hypotension in
diabetes patients?
 What is the appropriate dose of procainamide to treat
arrhythmia, particularly wide complex tachycardias?
 How often do patients with an intracranial bleed
present with fever?
Catch ‘em Quick!

Five Vital Signs
They’ll often be given as rapid speed numbers
with little explanation – everyone on a medical
team is expected to KNOW them instinctively.
“128-over-75 70 16 98.6 98%-on-room-air”
Note: not always given in the same order or all five at once
What are the vital signs?
BP = Blood Pressure
 HR = Heart Rate
 RR = Respiratory Rate
 Temperature
 O-2 sat = Blood oxygen saturation

Vital 1: BP = Blood Pressure

The pressure of the flow of blood in the body,
originating from the contractions of the heart
 Is reported as two numbers: Systolic/Diastolic
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The higher (systolic) number represents the
pressure while the heart contracts to pump blood to
the body.
The lower (diastolic) number represents the
pressure when the heart relaxes between beats.
Reading the BP
Most normal blood pressures fall in the
range of 90/60 mm Hg to 130/80 mm Hg
Systolic 90-130
Diastolic 60-80
 High BP = hypertension
 Low BP = hypotension
 BP may be higher in young children and
the elderly

Vital 2: HR = Heart Rate
AKA pulse; the rate at which the heart
contracts to pump blood through the body
 60-100 beats per minute is normal (> age
10)
 >100 = tachycardia = TOO FAST!
 <60 = bradycardia = TOO SLOW!!!
 Exercise can cause HR to increase
temporarily

Normal values for resting heart rate
newborn infants; 100 to 160 beats per
minute
 children 1 to 10 years; 70 to 120 beats
per minute
 children over 10 and adults; 60 to 100
beats per minute
 well-trained athletes; 40 to 60 beats per
minute

Vital 3: RR = Respiratory Rate

The number of breaths per minute or,
more formally, the number of movements
indicative of inspiration and expiration
per unit time. In practice, the respiratory
rate is usually determined by counting
the number of times the chest rises or
falls per minute.
Normal respiratory rate
For adults: 14-20 breaths per minute
 Newborns: higher, up to 44
 Infants: ~20-40
 Young children: 20-30 breaths per
minute
 Older children: 16-25 breaths per minute

If RR is ≥ 20, unless patient is young child,
be concerned!
Abnormal RR
Tachypnea = FAST RR
 Bradypnea = SLOW RR
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
Also note: dyspnea
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shortness of breath (SOB); difficulty
breathing or pain on breathing; can be
normal, tachy or brady depending on the
patient
Also note: apnea

Absence of breath (RR=0)
Vital 4: Temperature

The normal temperature varies by person,
age, time of day, and where on the body the
temperature was taken.
 The average normal body temperature is
98.6°F (37°C).
 Temperature is usually highest in the evening
and can be raised by exercise, strong emotion,
eating, heavy clothing, medications, high
ambient, and high humidity.
High Temperature
High Temperature = Fever =
hyperthermia
 A "significant" fever is usually defined

oral/ear temperature of 102º F
 rectal temperature of 103º F.


rectal temperature reading is generally 1 degree
Fahrenheit higher than an oral reading
Hypothermia
Low body temperature (≤ 95º F)
 Most common cause: immersion in cold
water
 Can be caused by substance abuse;
hypothyroidism, stroke, severe arthritis,
Parkinson's disease, trauma, spinal cord
injuries, and burns
 Extremes of age can also be associated
with hypothermia

Vital 5: Oxygen Saturation

The amount of oxygen bound to hemoglobin in
Red Blood Cells
 Measured by an oximeter (pulse oximeter)

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A pulse oximeter measures the light absorption
characteristics of O2-saturated hemoglobin
It should ALWAYS be >95%
 It is usually given as ‘O-2-sat on room air’ in
percentage form unless patient is receiving
oxygen
 Low O2 sat is a serious concern!
Sample Case 1

30 yr old male
 chief complaint (cc): ingestion of 8-10 pills
amiodarone; aspirin; altase; metoprolol;
diltiazem (suicide attempt)
 ABC: Airway, Breathing ok; Circulation – weak
pulses
 Vitals:
90/50 72 20 afebrile 95%ra
Which vitals are you worried about?
Sample Case 2
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55yo male
cc: worsening ankle pain
ABC: OK
Vitals
160/100 100 22 98%ra 104.1º
Physical Exam: disoriented with acute altered
mental status; flushed, diaphoretic
Glucose 108
What vitals are you worried about?
Sample Case 3
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21 yo male cc: severe abdominal pain
ABC ok
Vitals
123/74 129 18 96%ra 101ºC
Glucose 120
Phys Exam – RLQ TTP (right lower quadrant of
abdomen tender to palpation/touch)
Which Vitals are you worried about?
Sample Case 4
15 yr old male
 cc: wheezing, dyspnea (trouble
breathing)
 A and C ok; B – wheezes
 Vitals

100/70 120 30 89%ra 39ºC
Which vitals are you worried about?
Summary
Vital Signs Are VITAL!
128/70 70 16 98.6ºC 97%
BP
HR RR Temp O2-Sat
Resources
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http://www.nlm.nih.gov/medlineplus/ency/article
/002341.htm
http://en.wikipedia.org/wiki/Vital_signs
http://www.americanheart.org/presenter.jhtml?id
entifier=4473
http://www.nlm.nih.gov/medlineplus/ency/article
/003399.htm
http://www.healthsquare.com/mc/fgmc2504.htm
http://www.nlm.nih.gov/medlineplus/ency/article
/003090.htm
http://www.pulseox.info/