Vital signs

There are four primary vital signs which are standard in most medical settings:{{cite web | title = Vital Signs | publisher = Cleveland Clinic | url = https://my.clevelandclinic.org/health/articles/10881-vital-signs | access-date = 10 Sep 2020}}

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.{{cite web |date=2022-06-14 |title=Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure) |url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/vital-signs-body-temperature-pulse-rate-respiration-rate-blood-pressure |access-date=2023-11-06 |website=www.hopkinsmedicine.org |language=en}} Although a pulse can be taken by hand, a stethoscope may be required for a clinician to take a patient's apical pulse.{{cite web |title=Apical Pulse: What It Is and How to Take It |url=https://my.clevelandclinic.org/health/articles/23346-apical-pulse |access-date=2023-11-06 |website=Cleveland Clinic |language=en}}

Temperature recording gives an indication of core body temperature, which is normally tightly controlled (thermoregulation), as it affects the rate of chemical reactions. Body temperature is maintained through a balance of the heat produced by the body and the heat lost from the body.{{cite web |title=Vital Signs: How to Check My Vitals at Home |url=https://my.clevelandclinic.org/health/articles/10881-vital-signs |access-date=2023-11-06 |website=Cleveland Clinic |language=en}}

File:Thermometer (Oral Glass).png

Temperature can be recorded in order to establish a baseline for the individual's normal body temperature for the site and measuring conditions.

Temperature can be measured from the mouth, rectum, axilla (armpit), ear, or skin. Oral, rectal, and axillary temperature can be measured with either a glass or electronic thermometer. Note that rectal temperature measures approximately 0.5 °C higher than oral temperature, and axillary temperature approximately 0.5 °C less than oral temperature. Aural and skin temperature measurements require special devices designed to measure temperature from these locations.

While {{convert|37|°C|°F|abbr=on}} is considered "normal" body temperature, there is some variance between individuals. Most have a normal body temperature set point that falls within the range of {{convert|36.0|to|37.5|C|F}}.{{cite book|title=DeGowin's diagnostic examination|last1=LeBlond|first1=Richard F.|last2=Brown|first2=Donald D.|last3=Suneja|first3=Manish|last4=Szot|first4=Joseph F.|isbn=9780071814478|edition=10th|location=New York|publisher=McGraw-Hill Education|oclc=876336892|date=2014-09-05}}

The main reason for checking body temperature is to solicit any signs of systemic infection or inflammation in the presence of a fever. Fever is considered temperature of {{convert|37.8|°C|°F|abbr=on}} or above. Other causes of elevated temperature include hyperthermia, which results from unregulated heat generation or abnormalities in the body's heat exchange mechanisms.

Temperature depression (hypothermia) also needs to be evaluated. Hypothermia is classified as temperature below {{convert|35|°C|°F|abbr=on}}.

It is also recommended to review the trend of the patient's temperature over time. A fever of 38 °C does not necessarily indicate an ominous sign if the patient's previous temperature has been higher.

{{Main|Pulse}}

File:Pulse (Wrist).png

The pulse is the rate at which the heart beats while pumping blood through the arteries, recorded as beats per minute (bpm).{{cite web|url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/vital-signs-body-temperature-pulse-rate-respiration-rate-blood-pressure|title=Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)|website=www.hopkinsmedicine.org|language=en|access-date=2019-08-30}} It may also be called "heart rate". In addition to providing the heart rate, the pulse should also be evaluated for strength and obvious rhythm abnormalities. The pulse is commonly taken at the wrist (radial artery). Alternative sites include the elbow (brachial artery), the neck (carotid artery), behind the knee (popliteal artery), or in the foot (dorsalis pedis or posterior tibial arteries). The pulse is taken with the index finger and middle finger by pushing with firm yet gentle pressure at the locations described above, and counting the beats felt per 60 seconds (or per 30 seconds and multiplying by two). The pulse rate can also be measured by listening directly to the heartbeat using a stethoscope. The pulse may vary due to exercise, fitness level, disease, emotions, and medications. The pulse also varies with age. A newborn can have a heart rate of 100–⁠160 bpm, an infant (0–⁠5 months old) a heart rate of 90–⁠150 bpm, and a toddler (6–⁠12 months old) a heart rate of 80–140 bpm.{{cite web|date=2019-07-23|title=Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate| url=https://emedicine.medscape.com/article/2172054-overview#a2}} A child aged 1–⁠3 years old can have a heart rate of 80–⁠130 bpm, a child aged 3–⁠5 years old a heart rate of 80–⁠120 bpm, an older child (age of 6–10) a heart rate of 70–⁠110 bpm, and an adolescent (age 11–⁠14) a heart rate of 60–105 bpm. An adult (age 15+) can have a heart rate of 60–100 bpm.

{{main|Respiratory rate}}

Average respiratory rates vary between ages, but the normal reference range for people age 18 to 65 is 16–20 breaths per minute. 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 a clear indicator of acidotic states, as the main function of respiration is removal of CO₂ leaving bicarbonate base in circulation.

{{Main|Blood pressure#Measurement}}

{{Unreferenced section|date=September 2017}}

File:Sphygmomanometer.jpg

Blood pressure is recorded as two readings: a higher systolic pressure, which occurs during the maximal contraction of the heart, and the lower diastolic or resting pressure. In adults, a normal blood pressure is 120/80, with 120 being the systolic and 80 being the diastolic reading. 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, while 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).

In the U.S., in addition to the above four, many providers are required or encouraged by government technology-in-medicine laws to record the patient's height, weight, and body mass index.{{cite web|url=http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/record-vital-signs|title=What should I include when I record vital signs of my patients for MU? - Providers & Professionals - HealthIT.gov|access-date=2014-08-24|archive-date=2018-03-25|archive-url=https://web.archive.org/web/20180325142200/https://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/record-vital-signs|url-status=dead}} In contrast to the traditional vital signs, these measurements are not useful for assessing acute changes in state because of the rate at which they change; however, they are useful for assessing the impact of prolonged illness or chronic health problems.

The definition of vital signs may also vary with the setting of the assessment. Emergency medical technicians (EMTs), 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.Emergency Care, 11th edition, pp. 226–244.

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.{{cite web| url=http://www.va.gov/painmanagement/docs/toolkit.pdf | title=Pain as the 5Th Vital Sign Toolkit}} Pain is measured on a 0–⁠10 pain scale based on subjective patient reporting and may be unreliable.{{cite journal|title=How Reliable is Pain as the Fifth Vital Sign?|first1=Karl A.|last1=Lorenz|first2=Cathy D.|last2=Sherbourne|first3=Lisa R.|last3=Shugarman|first4=Lisa V.|last4=Rubenstein|first5=Li|last5=Wen|first6=Angela|last6=Cohen|first7=Joy R.|last7=Goebel|first8=Emily|last8=Hagenmeier|first9=Barbara|last9=Simon|first10=Andy|last10=Lanto|first11=Steven M.|last11=Asch|date=1 May 2009|journal=J Am Board Fam Med|volume=22|issue=3|pages=291–298|doi=10.3122/jabfm.2009.03.080162|pmid=19429735|doi-access=free}} Some studies show that recording pain routinely may not change management.{{cite journal|url=http://www.aafp.org/afp/2006/1015/p1417a.html|title=Tips From Other Journals - American Family Physician|journal=American Family Physician |date=15 October 2006 |volume=74 |issue=8 |pages=1417–1418 |last1=Wellbery |first1=Caroline }}{{cite journal | pmc = 1924634 | pmid=16808744 | doi=10.1111/j.1525-1497.2006.00415.x | volume=21 | issue=6 | title=Measuring pain as the 5th vital sign does not improve quality of pain management | year=2006 | journal=J Gen Intern Med | pages=607–12 |vauthors=Mularski RA, White-Chu F, Overbay D, Miller L, Asch SM, Ganzini L }}{{cite web| url=http://www.pain-initiative-un.org/doc-center/en/docs/The%20Fifth%20Vital%20Sign%20Implementation.pdf | access-date=2023-12-24 | title=The Fifth Vital Sign: Implementation of the Neonatal Infant Pain Scale | archive-url=https://web.archive.org/web/20120526120744/http://www.pain-initiative-un.org/doc-center/en/docs/The%20Fifth%20Vital%20Sign%20Implementation.pdf| archive-date=2012-05-26}}
• Menstrual cycle{{cite journal |author=American College of Obstetricians and Gynecologists. |title=Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Committee Opinion No. 651 |journal=Obstet Gynecol |volume=126 |pages=143–6 |year=2015 }}{{cite journal |publisher=American Academy of Pediatrics, Committee on Adolescence, American College of Obstetricians and Gynecologists, Committee on Adolescent Health Care. |title=Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign |journal=Pediatrics |volume=118 |issue=5 |year=2006 }}
• Oxygen saturation (as measured by pulse oximetry){{cite journal |author1=Mower W|author2=Myers G| author3= Nicklin E| author4=Kearin K|author5=Baraff L|author6=Sachs C |title=Pulse oximetry as a fifth vital sign in emergency geriatric assessment |journal=Acad Emerg Med |volume=5 |issue=9 |pages=858–65 |year=1998 |pmid=9754497 |doi=10.1111/j.1553-2712.1998.tb02813.x|doi-access=free }}{{cite journal |author1=Mower W|author2=Sachs C|author3=Nicklin E|author4=Baraff L |title=Pulse oximetry as a fifth pediatric vital sign |journal=Pediatrics |volume=99 |issue=5 |pages=681–6 |year=1997 |pmid=9113944 |doi=10.1542/peds.99.5.681|citeseerx=10.1.1.575.2200 }}{{cite journal |author=Neff T |title=Routine oximetry. A fifth vital sign? |journal=Chest |volume=94 |issue=2 |pages=227 |year=1988 |pmid=3396392 |doi=10.1378/chest.94.2.227a|doi-access=free }}
• Blood glucose level{{cite web|url=http://www2.hull.ac.uk/pgmi2/phd-scholarships-2016/mining-vital-signs.aspx|title=Mining Vital Signs from Wearable Healthcare Device via Nonlinear Machine Learning|publisher=University of Hull|access-date=2016-05-14|archive-date=2016-08-17|archive-url=https://web.archive.org/web/20160817005338/http://www2.hull.ac.uk/pgmi2/phd-scholarships-2016/mining-vital-signs.aspx|url-status=dead}}

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

• End-tidal {{CO2}}{{cite journal |author1=Vardi A|author2=Levin I|author3=Paret G|author4=Barzilay, Z |title=The sixth vital sign: end-tidal CO₂ in pediatric trauma patients during transport |journal=Harefuah |volume=139 |issue=3–4 |pages=85–7, 168 |year=2000 |pmid=10979461}}{{cite journal |pmid=16374268 | volume=59 | issue=4 | title=Manual vital signs reliably predict need for life-saving interventions in trauma patients | year=2005 | journal=J Trauma | pages=821–8; discussion 828–9 |vauthors=Holcomb JB, Salinas J, McManus JM, Miller CC, Cooke WH, Convertino VA | doi=10.1097/01.ta.0000188125.44129.7c}}
• Functional status{{cite journal |author=Bierman A |title=Functional Status: The Sixth Vital Sign |journal=J Gen Intern Med |volume=16 |issue=11 |pages=785–6 |year=2001 |pmc=1495293 |pmid=11722694 |doi=10.1111/j.1525-1497.2001.10918.x}}
• Shortness of breath{{cite web |url=http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=7008&nbr=4217#s21 |title=Nursing care of dyspnea: the 6th vital sign in individuals with chronic obstructive pulmonary disease (COPD). |publisher=National Guideline Clearinghouse |access-date=2009-01-16 |archive-url=https://web.archive.org/web/20090117040751/http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=7008&nbr=4217#s21 |archive-date=2009-01-17 |url-status=dead }}
• Gait speed{{cite journal |vauthors=Studenski S, Perera S, Wallace D, etal |title=Physical performance measures in the clinical setting |journal=J Am Geriatr Soc |volume= 51 |issue=9 |pages=314–322 |year=2003 |doi=10.1046/j.1532-5415.2003.51104.x |pmid=12588574|s2cid=31083716 |url=http://www.jhsph.edu/research/centers-and-institutes/roger-c-lipitz-center-for-integrated-health-care/Pra_PraPlus/studenski_et_al.pdf }}
• Delirium{{cite journal|url=https://www.jamda.com/article/S1525-8610(08)00072-8/abstract|title=Delirium as the Sixth Vital Sign|first1=Giuseppe|last1=Bellelli|first2=Marco|last2=Trabucchi|date=May 1, 2008|journal=Journal of the American Medical Directors Association|volume=9|issue=4|pages=279; author reply 279–80|via=www.jamda.com|doi=10.1016/j.jamda.2007.08.014|pmid=18457806}}

Children and infants have respiratory and heart rates that are faster than those of adults as shown in the following table :

Monitoring of vital parameters most commonly includes 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 intensive 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 the general condition of a patient.

While monitoring has traditionally been done by nurses and doctors, a number of companies are developing devices that can be used by consumers themselves. These include Cherish Health, Scanadu and Azoi.

• Biotelemetry
• Medical record
• Remote patient monitoring

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Category:Medical signs

Category:Physical examination

fr:Signes vitaux