“ Vital Signs are…Vital!” Jennifer Lyon, M.S., M.L.I.S. [email_address]

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

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?

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

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

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 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.

The pressure of the flow of blood in the body, originating from the contractions of the heart

Is reported as two numbers: Systolic/Diastolic

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 = hyp er tension Low BP = hyp o tension BP may be higher in young children and the elderly

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 = hyp er tension

Low BP = hyp o tension

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

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

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.

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!

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 Also note: dyspnea 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)

Tachypnea = FAST RR

Bradypnea = SLOW RR

Also note: dyspnea

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.

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 &quot;significant&quot; fever is usually defined oral/ear temperature of 102 º F rectal temperature of 103 º F. rectal temperature reading is generally 1 degree Fahrenheit higher than an oral reading

High Temperature = Fever = hyperthermia

A &quot;significant&quot; fever is usually defined

oral/ear temperature of 102 º F

rectal temperature of 103 º F.

rectal temperature reading is generally 1 degree Fahrenheit higher than an oral reading

Hypothermia Low body temperature ( ≤ 95 º 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

Low body temperature ( ≤ 95 º 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) A pulse oximeter measures the light absorption characteristics of O 2 -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 O 2 sat is a serious concern!

The amount of oxygen bound to hemoglobin in Red Blood Cells

Measured by an oximeter (pulse oximeter)

A pulse oximeter measures the light absorption characteristics of O 2 -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 O 2 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?

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 55yo male cc: worsening ankle pain ABC: OK Vitals 160/100 100 22 98%ra 104.1 º Physical Exam: disoriented with acute altered mental status; flushed, diaphoretic Glucose 108 What vitals are you worried about?

55yo male

cc: worsening ankle pain

ABC: OK

Vitals

160/100 100 22 98%ra 104.1 º

Physical Exam: disoriented with acute altered mental status; flushed, diaphoretic

Glucose 108

What vitals are you worried about?

Sample Case 3 21 yo male cc: severe abdominal pain ABC ok Vitals 123/74 129 18 96%ra 101 ºC Glucose 120 Phys Exam – RLQ TTP (right lower quadrant of abdomen tender to palpation/touch) Which Vitals are you worried about?

21 yo male cc: severe abdominal pain

ABC ok

Vitals

123/74 129 18 96%ra 101 ºC

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 39 ºC Which vitals are you worried about?

15 yr old male

cc: wheezing, dyspnea (trouble breathing)

A and C ok; B – wheezes

Vitals

100/70 120 30 89%ra 39 ºC

Which vitals are you worried about?

Summary Vital Signs Are VITAL! 128/70 70 16 98.6 ºC 97% BP HR RR Temp O2-Sat

Vital Signs Are VITAL!

128/70 70 16 98.6 ºC 97%

BP HR RR Temp O2-Sat

Resources http://www.nlm.nih.gov/medlineplus/ency/article/002341.htm http://en.wikipedia.org/wiki/Vital_signs http://www.americanheart.org/presenter.jhtml?identifier=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 /

http://www.nlm.nih.gov/medlineplus/ency/article/002341.htm

http://en.wikipedia.org/wiki/Vital_signs

http://www.americanheart.org/presenter.jhtml?identifier=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 /