Vital Signs

Pulse

Examination Sites

• Radial artery.
• Cartoid artery.*
• Brachial artery.
• Popliteal artery.
• Posterior tibial artery.
• Dorsalis pedis artery.

*When taking the pulse at the carotid artery, take caution to not place too much pressure on both sides of the neck simultaneously, as this leads to tachycardia & in some cases, fainting. The carotid pulse should be felt on one side only.

Examination

• Place 3 fingers over site of examination.
  
  • 1 finger to count pulse.
  • 1 finger to examine character of pulse (fast/slow, regular/irregular etc.).
  • 1 finger to examine condition of blood vessel (elastic/inelastic, enlarged/normal etc.).
• Palpate for 30 seconds, shorter if pulse likely to change.
• Express result as beats per minute (bpm).

The normal pulse is 65-72 bpm.

Bradycardia can be due to:

• In resting state (sleep).
• Expiration of air, due to changes in venous return to heart.
• Hypothermia.
• Extreme malnutrition.
  
• Underlying medical conditions (hypertension, hypothyroidism etc.).
• Subject is in excellent physical condition (athletic heart syndrome).
  

Tachycardia can be due to:

• Exercise.
• Inspiration of air, due to changes in venous return to heart.
• Fever.
• Hyperventilation.
• Sympathetic stimulation.
• Pregnancy.
• Female subjects on birth-control pills/hormone replacement therapy.
• Underlying medical conditions (chronic kidney disease, hyperthyroidism, sleep apnea etc.).
• Certain medications (asthma, cold-relief products etc.)

Blood Pressure
Korotkoff Sounds

• Phase I
  
  • A sound is first heard over the artery - Systolic blood pressure.
• Phase II
  
  • Sound increases in intensity as cuff is further deflated.
• Phase III
  
  • Sound decreases in intensity.
• Phase IV
  
  • Sound becomes muffled.
• Phase V
  
  • Sound disappears - Diastolic blood pressure.

Examination

• Expose the upper arm.
• Ensure the patient is relaxed.
• Position upper arm at heart level.
• Secure sphygmomanometer cuff to the bare upper arm 3-5cm above cubital fossa.
• Palpate the radial pulse.
• Rapidly raise pressure until radial pulse disappears.*
• Continue with the palpatory method or the auscultatory method.

*If done slowly, limb becomes congested & painful.

Palpatory Method

• Release pressure at 3 mm Hg per second until radial pulse returns.
• Manometer reading is recorded as the systolic pressure.

Auscultatory Method

• Place a stethoscope over the brachial artery, just above the bend of the elbow, to the inner side of the biceps tendon, not more than 5 cm from the lower edge of the cuff.
• Listen carefully while releasing the pressure at 3 mm Hg per second.
• Record the systolic pressure when a clear sound is audible with each heart beat (Korotkoff Phase I).
• Continue to release pressure.
  
  • The intensity initially become louder, prolonged & murmuring.
  • The intensity then remains static for a period.
  • The intensity then rapidly declines.
• Record the diastolic pressure when the sound finally disappears (Korotkoff Phase V).

Caution:

• Auscultatory gap
  
  • Korotkoff sounds disappear just below systolic pressure, but returns before the diastolic pressure.
  • Can occur in healthy people or those with hypertension.
• Falsely low systolic pressure
  Cuff is not initially inflated to a high enough pressure to exceed true systolic pressure.
  Initial sounds are missed.
  Can be overcome by checking with the palpatory method.

The normal blood pressure is 120/80 mm Hg (systolic/diastolic).

Variations

• Men's mean systolic blood pressure is 6-10 mm Hg higher than women.
• Age.
• Ethinicity.
• Emotion.
• Exertion.
• Sleep deprivation.
• Large meals.
• Exposure to hot & cold.
• Smoking.
• Posture.

Respiratory Rate
Count the respiratory rate over 1 minute.

The normal rate in an adult is 12-14; it is higher in children, depending on age.

Typically done simultaneously when taking pulse by watching chest movements.

Gender Differences

• Women exhibit thoraco-abdominal breathing.
  
  • They respire using the intercoastal muscles more.
• Men exhibit abdomino-thoracic breathing.
  
  • They respire using the diaphragm more.

Temperature
Examination Sites

• Orally.
• On the skin.
• Rectally.*
• Axilla.
• In the ear.

* Remains most accurate in young children.

Variations

• Oral temperature is 37 °C.
• Axilla temperature is 36.5°C (0.5°C lower).
• Rectal temperature is 37.5°C (0.5°C higher).
• Diurnal variation.
• Varies across the menstrual cycle in women.

Hypothermia can be due to:

• Environmental cold exposures.
• Shock.
• Underlying medical conditions (diabetes, hypothyroidism etc.).

Hyperthermia can be due to:

• Environmental heat exposures.
• Exercise.
• Fever.
• Dehydration.
• Poor circulation.
• Drug & alcohol use.
• Underlying medical conditions (heart disease, hyperthyroidism etc.)