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