Vital Signs

Vital Signs

General

  • Wash your hands upon entering the room
  • Introduce yourself and the exam to the patient in a way that the patient will understand
  • Patient should be supine on a flat bed
  • Ask the patient to roll up their sleeves for measuring blood pressure

Measuring Vital Signs

Vital signs should be measured on every patient. They consist of the following measurements: Blood pressure, heart rate, respiratory rate, and temperature. Oxygen saturation is often added to the vital signs. The normal values below are given for adults.

  • Blood Pressure
    • By Palpation
      • Ensure the patient has been resting in the seated or supine position for five minutes
      • Locate the brachial artery by palpating in the antecubital fossa
      • Put the correct sized cuff on the patient's arm approximately 1cm above the antecubital fossa. Ensure the marker lines up with the brachial artery
        • The width of the appropriate sized cuff should be greater than 40% of the circumference of the patient's upper arm
      • While palpating the radial artery, inflate the cuff until the radial pulse is no longer palpable
      • Slowly deflate the cuff at 2mm Hg/second until the radial pulse reappears. This point is the systolic blood pressure
    • By Auscultation
      • Leaving the cuff on, place the diaphragm of your stethoscope over the brachial artery
      • Reinflate the cuff to 30mm Hg above the systolic blood pressure as determined by palpation. This will ensure that you do not fall in the auscultatory gap
      • Slowly deflate the cuff at 2mm Hg/second until you begin to hear Korotkoff sounds. This is the systolic blood pressure
      • Continue to deflate the cuff at the same rate until the sounds disappear. This is the diastolic blood pressure
    • The blood pressure should be measured in both arms
    • Normal = 120/80 mm Hg
  • Heart Rate & Respiratory Rate
    • Heart Rate - Palpate the radial artery and count the number of beats in 30 seconds. Multiply this by 2 to calculate the heart rate in beats per minute
      • Normal = 60bp, Bradycardia = <60bp, Tachycardia = >100bpm
      • In addition to the rate, comment on the rhythm and amplitude.
        • The rhythm is commonly described as regular, regularly irregular, or irregularly irregular
        • The amplitude is scored on a scale of 0-4:
          • 0 = Absent
          • 1 = Diminished
          • 2 = Normal
          • 3 = Increased
          • 4 = Aneurysmal
    • Respiratory Rate - Determine the respiratory rate immediately after the pulse while still palpating the radial artery. Count the number of breaths the patient takes in 30 seconds. Multiply this by 2 to calculate the respiratory rate in breaths per minute
      • Normal - 12-16 breaths/minute
      • Tachypnea - >16 breaths/minute
      • In addition to the rate, also comment on the respiratory effort and rhythm
  • Temperature
    • There are multiple methods of measuring temperature: Oral, axillary, rectal, or tympanic membrane

 Table 1: Body Temperature Techniques. Table adapted from the University of Toronto Clinical Skills Handbook

Table 1: Body Temperature Techniques. Table adapted from the University of Toronto Clinical Skills Handbook

    • When reporting the temperature, note both the temperature and the method used
  • Oxygen Saturation
    • Vital signs will often include oxygen saturation, especially in hospital settings
    • Typically measured using a pulse oximeter
    • When reporting the oxygen saturation, note the oxygen saturation, and the type of air the patient is breathing (ie room air, 3L of O2 etc)
      • Normal - 97-99% on room air

Orthostatic Vital Signs

In patients where ECF volume depletion is suspected, orthostatic vitals should be performed:

  • Orthostatic Blood Pressure
    • Measure the blood pressure with the patient supine
    • Ask the patient to stand. Be sure to support them in case they fall
    • After 2 minutes, repeat the blood pressure with the patient standing
      • Orthostatic Hypotension is defined by a >20mm Hg drop in systolic pressure or a >10mm Hg drop in diastolic pressure when the patient stands up
  • Orthostatic Pulse
    • Measure the pulse with the patient supine
    • Ask the patient to stand. Be sure to support them in case they fall
    • After 2 minutes, repeat the pulse measurement with the patient standing
      • The test is positive if there is a >20 bpm increase in the pulse when the patient stands up