Vital signs

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.

Primary four

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

The equipment needed is a thermometer, a sphygmomanometer, and a watch with a second hand.

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

Additional signs

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 pulse oximetry 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]

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]
Oxygen saturation level
Intracranial pressure
Skin signs (color)

Variations by age

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

Age	Normal heart rate (beats per minute)^[12]	Normal respiratory rate (breaths per minute)^[13]
Newborn	200-260	30-50
0-5 months	90-190	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

References

↑ Harold S. Lee. November 2004. Physical Diagnosis 101: A Lesson From the First Year of Medical School, in Letters to the Editor. American Society of Anesthesiologists, Volume 68, Number 11.
↑ 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. PMID 9754497.
↑ Mower W, Sachs C, Nicklin E, Baraff L (1997). "Pulse oximetry as a fifth pediatric vital sign". Pediatrics. 99 (5): 681–6. PMID 9113944.
↑ Neff T (1988). "Routine oximetry. A fifth vital sign?". Chest. 94 (2): 227. PMID 3396392.
↑ Daniel Limmer and Michael F. O'Keefe. 2005. Emergency Care 10th ed. Edward T. Dickinson, Ed. Pearson, Prentice Hall. Upper Saddle River, New Jersey. Page 212 and 218.
↑ Joseph A (2003). "Continence: the sixth vital sign?". Am J Nurs. 103 (7): 11. PMID 12865635.
↑ Vardi A, Levin I, Paret G, Barzilay Z (2000). "The sixth vital sign: end-tidal CO2 in pediatric trauma patients during transport". Harefuah. 139 (3–4): 85–7, 168. PMID 10979461.
↑ Bultz B, Carlson L (2006). "Emotional distress: the sixth vital sign--future directions in cancer care". Psychooncology. 15 (2): 93–5. PMID 16444764. link
↑ http://www.ohsu.edu/medicine/residency/handouts/0405handouts/COPD091304.ppt
↑ http://www.medicine.uiowa.edu/cme/about/documents/PrintHandout.ppt
↑ Bierman A (2001). "Functional status: the sixth vital sign". J Gen Intern Med. 16 (11): 785–6. PMID 11722694. link
↑ Emergency Care, Page 214
↑ Emergency Care, Page 215

Template:Nursing

Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs

Template:WH Template:WS

[1] Harold S. Lee. November 2004. Physical Diagnosis 101: A Lesson From the First Year of Medical School, in Letters to the Editor. American Society of Anesthesiologists, Volume 68, Number 11.

[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. 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. PMID 9113944.

[4] Neff T (1988). "Routine oximetry. A fifth vital sign?". Chest. 94 (2): 227. PMID 3396392.

[brady-5] Daniel Limmer and Michael F. O'Keefe. 2005. Emergency Care 10th ed. Edward T. Dickinson, Ed. Pearson, Prentice Hall. Upper Saddle River, New Jersey. Page 212 and 218.

[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 CO2 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. PMID 16444764. link

[9] ttp://www.ohsu.edu/medicine/residency/handouts/0405handouts/COPD091304.ppt

[10] ttp://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. PMID 11722694. link

[12] Emergency Care, Page 214

[13] Emergency Care, Page 215

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v t e Symptoms and signs: circulatory (R00–R03, 785)
Cardiovascular	Template:Navbox subgroup
Myeloid/blood	Template:Navbox subgroup

v t e Symptoms and signs: respiratory system (R04–R07, 786)
Hemorrhage	Epistaxis Hemoptysis
Abnormalities of breathing	Respiratory sounds Stridor Wheeze Crackles Rhonchi Hamman's sign Apnea Dyspnea Hyperventilation/Hypoventilation Hyperpnea/Tachypnea/Hypopnea/Bradypnea Orthopnea/Platypnea Trepopnea Biot's respiration Cheyne-Stokes respiration Kussmaul breathing Hiccup Mouth breathing/Snoring Breath-holding
Other	Asphyxia Cough Pleurisy Sputum Respiratory arrest Hypercapnia/Hypocapnia Pectoriloquy: Whispered pectoriloquy Egophony Bronchophony Pleural friction rub Fremitus Silhouette sign
Chest, general	Chest pain Precordial catch syndrome

v t e Symptoms and signs: digestive system and abdomen (R10–R19, 787,789)
GI tract	Template:Navbox subgroup
Accessory	Hepatosplenomegaly/Hepatomegaly Jaundice
Abdominopelvic	Ascites
Abdominal – general	Abdominal pain (Acute abdomen, Colic, Baby colic) Splenomegaly Abdominal guarding · Abdominal mass · Rebound tenderness Shifting dullness · Bulging flanks · Puddle sign · Fluid wave test

v t e Symptoms and signs: Symptoms concerning nutrition, metabolism and development (R62–R64, 783)
Ingestion/Weight	decrease: Anorexia • Weight loss/Cachexia/Underweight increase: Polyphagia • Polydipsia • Orexigenia • Weight gain
Growth	Delayed milestone • Failure to thrive • Short stature (e.g., Idiopathic)