For the Pakistani pop group, see Vital Signs (band).

For other uses, see Vital signs

(disambiguation).

Vital signs are measures of various physiological statistics, often taken by health
professionals, in order to assess the most basic body functions. Vital signs are an essential
part of a case presentation. The act of taking vital signs normally entails recording Body
temperature, Pulse rate (or heart rate), Blood pressure, and Respiratory rate, but may also
include other measurements. Vital signs often vary by age.

Primary four
There are four vital signs which are standard in most medical settings:

1. Body temperature
2. Pulse rate (or heart rate)
3. Blood pressure
4. Respiratory rate

The equipment needed is a thermometer, a sphygmomanometer, and a watch.

Though a pulse can often be taken by hand, a stethoscope may be required for a patient
with a very weak pulse.

[edit] Temperature

Temperature recording gives an indication of core body temperature which is normally

tightly controlled (thermoregulation) as it affects the rate of chemical reactions.

Temperature can be recorded in order to establish a baseline for the individual's normal
temperature for the site and measuring conditions. The main reason for checking body
temperature is to solicit any signs of systemic infection or inflammation in the presence of a
fever (temp > 38.5°C or sustained temp > 38°C), or elevated significantly above the
individuals normal temperature. Other causes of elevated temperature include
hyperthermia.

Temperature depression (hypothermia) also needs to be evaluated. It is also noteworthy to

review the trend of the patient's temperature. A patient with a fever of 38°C does not
necessarily indicate an ominous sign if his previous temperature has been higher.

[edit] Blood pressure

Main article: blood pressure#Measurement

The blood pressure is recorded as two readings; a high systolic pressure, which is the
maximal contraction of the heart, and the lower diastolic or resting pressure. A normal
blood pressure would be 120 being the systolic over 80, the diastolic. Usually the blood
pressure is given in 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, whilst 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 is called
segmental blood pressures and are used to evaluate blockage or arterial occlusion in a limb
(see Ankle brachial pressure index).

[edit] Pulse

Main article: Pulse

The pulse is the physical expansion of the artery. Its rate is usually measured either at the
wrist or the ankle and is recorded as beats per minute. The pulse commonly taken is the
radial artery at the wrist. Sometimes the pulse cannot be taken at the wrist and is taken at
the opposite of the elbow (brachial artery), at the neck against the carotid artery (carotid
pulse), behind the knee (popliteal artery), or in the foot dorsalis pedis or posterior tibial
arteries. The pulse rate can also be measured by listening directly to the heartbeat using a
stethoscope. The pulse varies with age. A newborn or infant can have a heart rate of about
130-150 beats per minute. A toddler's heart will beat about 100-120 times per minute, an
older child's heartbeat is around 90-110 beats per minute, adolescents around 80-100 beats
per minute, and adults pulse rate is anywhere between 50 and 80 beats per minute.

[edit] Respiratory rate

Main article: Respiratory rate

Varies with age, but the normal reference range for an adult is 12-20 breaths/minute.[citation
needed]
The value of respiratory rate as an indicator of potential respiratory dysfunction has
been investigated but findings suggest it is of limited value.

[edit] Additional signs

While various additional signs have been proposed, none have been officially universally
adopted due to the expense in obtaining equipment required to diagnose and the difficulty
in training entry-level professionals.

[edit] Fifth sign

The phrase "fifth vital sign" usually refers to pain, as perceived by the patient on a Pain
scale of 0–10. For example, the Veterans Administration made this their policy in 1999.
However, some doctors have noted that pain is actually a subjective symptom, not an
objective sign, and therefore object to this classification.[1]

Other sources include oxygen saturation as their fifth sign.[2][3][4]

Some sources consider pupil size, equality, and reactivity to light to be a vital sign as well.
[5]

Many EMS agencies in the USA use Pulse Oximetry and Blood Glucose Level as vital
signs in addition to Pulse, Respitory Rate, and Blood Pressure.

[edit] Sixth sign

There is no standard "sixth vital sign", and the use is much more informal and discipline-
dependent than with the above, but some proposals (excluding the fifth sign candidates
above) include:

 Urinary continence[6]
 End-tidal CO2[7]
 Emotional distress[8]
 Spirometry[9]
 Glucose[10]
 Functional Status[11]
 Intracranial pressure[citation needed]
 Skin signs (color)[citation needed]

 Shortness of breath[12]
 Molecular Genetics, in Oncology[citation needed]
 Gait Speed[13]

[edit] Variations by age

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

Normal heart rate Normal respiratory rate

Age [14]
(beats per minute) (breaths per minute)[15]
Newborn 100-160 [16] 30-50
0–5 months 90-150 25-40
6–12 months 80-140 20-30
 1–3 years 80-130 20-30
3–5 years 80-120 20-30
6–10 years 70-110 15-30
11–14 years 60-105 12-20
14+ years 60-100 12-20

[edit] See also

 Biotelemetry

[edit] References
1. ^ Lee HS (November 2004). "Letters to the Editor: Physical Diagnosis 101: A Lesson From
the First Year of Medical School". American Society of Anesthesiologists Newsletter 68
(11). http://www.asahq.org/Newsletters/2004/11_04/lte11_04.html.
2. ^ Mower W, Myers G, Nicklin E, Kearin K, Baraff L, Sachs C (1998). "Pulse oximetry as a
fifth vital sign in emergency geriatric assessment". Acad Emerg Med 5 (9): 858–65.
doi:10.1111/j.1553-2712.1998.tb02813.x. PMID 9754497.
3. ^ Mower W, Sachs C, Nicklin E, Baraff L (1997). "Pulse oximetry as a fifth pediatric vital
sign". Pediatrics 99 (5): 681–6. doi:10.1542/peds.99.5.681. PMID 9113944.
4. ^ Neff T (1988). "Routine oximetry. A fifth vital sign?". Chest 94 (2): 227.
doi:10.1378/chest.94.2.227a. PMID 3396392.
5. ^ Dickinson, Edward C.; Limmer, Daniel; O'Keefe, Michael F., ed (2005). Emergency care
(10th ed.). Upper Saddle River, N.J: Pearson/Prentice Hall. pp. 212, 218. ISBN 0-13-
114233-X.
6. ^ Joseph A (2003). "Continence: the sixth vital sign?". Am J Nurs 103 (7): 11.
PMID 12865635.
7. ^ Vardi A, Levin I, Paret G, Barzilay Z (2000). "The sixth vital sign: end-tidal CO 2 in
pediatric trauma patients during transport". Harefuah 139 (3-4): 85–7, 168.
PMID 10979461.
8. ^ Bultz B, Carlson L (2006). "Emotional distress: the sixth vital sign—future directions in
cancer care". Psychooncology 15 (2): 93–5. doi:10.1002/pon.1022. PMID 16444764.
http://www.jco.org/cgi/content/full/23/26/6440.
9. ^ http://www.ohsu.edu/medicine/residency/handouts/0405handouts/COPD091304.ppt
10. ^ "Glycemic Control in the Hospitalized Patient" (Powerpoint). University of Iowa.
http://www.medicine.uiowa.edu/cme/about/documents/PrintHandout.ppt.
11. ^ Bierman A (2001). "Functional status: the sixth vital sign". J Gen Intern Med 16 (11):
785–6. doi:10.1111/j.1525-1497.2001.10918.x. PMID 11722694.
12. ^ "Nursing care of dyspnea: the 6th vital sign in individuals with chronic obstructive
pulmonary disease (COPD).". National Guideline Clearinghouse.
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=7008&nbr=4217#s21.
13. ^ Studenski S, Perera S, Wallace D, et al (2003). "Physical performance measures in the
clinical setting". J Am Geriatr Soc 51 (9): 314–322. doi:10.1046/j.1532-5415.2003.51104.x.
14. ^ Emergency Care, Page 214
 15. ^ Emergency Care, Page 215
16. ^ Profile of a healthy baby includes a normal newborn exam with no evidence of:

[edit] External links

 JBI

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