Vital Signs
Vital signs are
measurements of the body's
most
Normal basic
vital signs functions
change with :
age
sex
weight
exercise tolerance
overall health
Primary vital signs:
Pulse (heart rate)
Blood pressure
Temperature
Breathing rate (respiratory rate)
Additional signs or Fifth
vital signs
The "fifth vital sign" may refer to a few
different parameters
Pain
Glasgow Coma Scale
Pulse Oximetry
Blood Glucoselevel
Heart rate (HR)
Heart rate is the speed of
theheartbeatmeasured by the
number of heartbeats per unit
oftime typicallybeats per
minute(bpm).
Heart rate can be changed
by:
physical exercise
sleep
anxiety
stress
illness
ingesting
drugs
endocrine and nervous system status
Heart rate measurement
Manual
by pressuring (palpation) it with the index and
middle fingers at any point on the body where
the artery's pulsation is transmitted to the surface
by listening to the heart beat directly (auscultation)
Electronic
Electrocardiograph (ECG) is more precise method
of determining heart rate based on electrical activity
of the heart
pulseoxymetry device and other devises
Manual HR measurement
Pulse palpation HR auscultetion
Portable pulseoxymetry device
SpO2
Heart rate
Pulse
Pressure wavesgenerated by the
heart insystolemove the arterial
walls. Forward movement
ofbloodoccurs when the boundaries
are pliable and compliant.
Diastolicblood pressureis non-
palpable and unobservable by tactile
methods, occurring between
heartbeats
Pulse Wave
Possible points for
measuring the pulse rate
The
ventral
aspect
of
thewrist
Characteristics of Pulse
Rate
Rhythm
Volume
Force
Tension
Form
Pulse rate
Normal pulse rates at rest, in beats per minute (BPM)
Newborn infants (3 infants(6 children(1 children well-trained
(03 6 months) 12 months) 10 years) over 10 adult
months old) years& athletes
adults,
including
seniors
100-150 90120 80-120 70130 60100 4060
Heart rate
The normal resting adult human heart
rate ranges from 60100 bpm
Bradycardiais a slow heart rate,
defined as below 60 bpm.
Tachycardiais a fast heart rate,
defined as above 100 bpm at rest
Rhythm
A normal pulse is regular in
rhythm and force.
An irregular pulse may be due to:
sinus arrhythmia,
premature beats,
ectopic beats,
atrial fibrillation,
Irregular (or intermittent) pulse
regularintermittent (regularly
irregular) pulse (pulsus
bigeminus,pulsus trigeminus for
example)
irregularintermittent (irregularly
Pulse volume
Volume, or amplitude, is the degree of
expansion displayed by artery during
diastolic and systolic state
Hypokinetic pulse - a weak pulse
signifies narrowpulse pressure
Hyperkinetic pulse - a bounding
pulse signifies high pulse pressure
Pulse volume
The strength of the pulse
can also be reported:
0 = Absent
1 = Barely palpable
2 = Easily palpable
3 = Full
4 = Aneurysmal orBounding
pulse
Force
Also known as compressibility of pulse.
It roughly reflects systolic blood
pressure.
Tension corresponds todiastolic blood
pressure.
A low tension pulse (pulsus mollis),
the vessel is soft or impalpable
between beats.
Pulse Form
A quickly rising and quickly falling
pulse (pulsus celer) is seen in aortic
regurgitation
A slow rising and slowly falling pulse
(pulsus tardus et parvus) is seen
in aortic stenosis
pulsusbisferiensapulsecharacteri
Pulse Form
1 - normal
2 -pulsus parvus
3 -pulsus parvus et
tardus
4 -pulsus filiformis
5 -pulsus celer, altus
et magnus
6 -pulsus dicroticus
Pulse Patterns
Several pulse patterns can be of clinical significance. These
include:
Pulsus alternans: an ominous medical sign that
indicates progressive systolic heart failure. A pattern of
a strong pulse followed by a weak pulse over and over
again. This pulse signals a flagging effort of the heart to
sustain itself in systole.
Pulsus bigeminus: indicates a pair of hoofbeats
within each heartbeat. Concurrentauscultationof the heart
may reveal agallop rhythmof the native heartbeat
Pulsus paradoxus: a condition in which some
heartbeats cannot be detected at the radial artery
during the inspiration phase of respiration. It is caused
Pulsus paradoxus
Equality
Comparing pulses and different
places gives valuable clinical
information.
A discrepant or unequal pulse between left
and right radial artery is observed in
anomalous or aberrant course of artery,
coarctation of aorta, aortitis, dissecting
aneurysm, peripheral embolism etc.
Pulse deficit
Pulse rate (PR)represents the
tactilearterialpalpationof
theheartbeat
Heart rate (HR) is determined
byauscultationor audiblesoundsat
the heart apex.
Pulse deficit = HR PR
Blood pressure
Blood pressure(BP), or arterial blood
pressure, is thepressureexerted by
circulatingbloodupon the walls of
blood vessels
Blood pressure varies depending on:
age
gender
situation
Blood pressure
Systemic arterial pressure
Mean arterial pressure
Pulse pressure
Systemic venous pressure
Pulmonary pressure
Systemic arterial
pressure
Systolic - refers to blood pressure
when the heart beats while
pumping blood
Diastolic - refers to blood
pressure when the heart is at
rest between beats
Blood pressure categories defined
by the American Heart Association
Diastolic
Blood Pressure Systolic
mm Hg (lower
Category mm Hg (upper #)
#)
Normal less than120 and less than80
Prehypertension 120139 or 8089
High Blood Pressure
140159 or 9099
(Hypertension) Stage 1
High Blood Pressure
160or higher or 100or higher
(Hypertension) Stage 2
Hypertensive Crisis
(Emergency care Higher than180 or Higher than110
needed)
nic hypertension is a risk factor for many complications, includingperipheral vas
ase,heart attack, andstroke.
Before measuring BP
1. Do not measure your blood
pressure within 30 minutes of drinking
caffeine or smoking.
2.Before you take readings, the
patient should rest for five minutes.
3.Push the sleeve up comfortably.
4.Patient should be sitting down ,
preferably at a desk or table, with your
arm resting on a firm surface
Measuring of BP
Mean arterial pressure
(MAP)
Mean arterial pressure (MAP) is
defined as the average arterial
pressure during a singlecardiac cycle
and describes an averageblood
pressurein an individual. It is
considered to be theperfusion
pressureseen byorgansin the body.
MAPis normally between 70 to
110mmHg
Mean arterial pressure
(MAP)
MAP = (CO SVR) + CVP
CO - cardiac output
SVR - systemic vascular resistance
CVP - central venous pressure
MAP Pdias+1/3 (Psys Pdias)
Pulse pressure (Ppulse)
Pulse pressureis the difference
between
thesystolicanddiastolicpressure
readings and is measured in
millimeters of mercury (mmHg). It
represents the force that the heart
generates each time it contracts
Ppulse = Psys Pdias
Psys systolic pressure
Low (Narrow) Pulse
Pressure
A pulse pressure is considered low if it
is less than 25% of the systolic value.
The most common cause of a low
(narrow) pulse pressure is :
a drop in left ventricular stroke
volume
significant blood loss (insufficient
preload leading to reduced cardiac
High (Wide) Pulse
Pressure
High values during or shortly
after exercise
Consistently (constantly) high
values
Causes of pulse pressure
widening
Atherosclerosis
Arteriovenous fistula
Chronic aortic regurgitation
Thyrotoxicosis
Fever
Anemia
Pregnancy
Cushings Triad
Irregular respirations (caused by
impaired brainstem function)
Bradycardia
Hypertension (High Pulse
Pressure)
High (Wide) Pulse
Pressure
a 10mm Hg increase in pulse
pressure increased the risk of major
cardiovascular complications and
mortality by nearly 20%
a risk factor for the development
ofatrial fibrillation
Systemic venous
pressure
Venous pressure is the vascular
pressure in aveinor in theatria of the
heart. It values of 5mm Hg in theright
atrium and 8mm Hg in the left atrium.
Variants of venous pressure include:
Central venous pressure, which is a
good approximation of right atrial
pressure, which is a major
Pulmonary pressure
Normally, the pressure in
thepulmonary arteryis about 15mm
Hg at rest.
Increased blood pressure in the
capillaries of the lung causepulmonary
hypertension, withinterstitial edemaif
the pressure increases to above
20mm Hg, and topulmonary edema
at pressures above 25mm Hg.
Complications
Hypotension
Blood pressure that is too low is known
ashypotension. Hypotension is a
medical concern if it causes signs or
symptoms, such as dizziness, fainting,
or in extreme cases,shock.
When arterial pressure and
bloodflowdecrease beyond a certain
point, theperfusionof the brain
becomes critically decreased (i.e., the
