1. “Vital Signs are…Vital!” Jennifer Lyon, M.S., M.L.I.S. Jennifer.Lyon@Vanderbilt.edu

2. 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

3. 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?

4. 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

5. What are the vital signs? BP = Blood Pressure HR = Heart Rate RR = Respiratory Rate Temperature O-2 sat = Blood oxygen saturation

6. 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.

7. 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

8. 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

9. 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

10. 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.

11. 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!

12. 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)

13. 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.

14. 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

15. 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

16. 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!

17. 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?

18. Sample Case 2 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?

19. Sample Case 3 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?

20. 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?

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

22. Resources http://www.nlm.nih.gov/medlineplus/ency/article /002341.htm http://www.nlm.nih.gov/medlineplus/ency/article /002341.htm http://en.wikipedia.org/wiki/Vital_signs http://www.americanheart.org/presenter.jhtml?i dentifier=4473 http://www.americanheart.org/presenter.jhtml?i dentifier=4473 http://www.nlm.nih.gov/medlineplus/ency/article /003399.htm 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.nlm.nih.gov/medlineplus/ency/article /003090.htm http://www.pulseox.info/