Assessment of Vital Signs

Vital signs provide important, basic information about a persons’ physiological state.
These relate primarily to cardiac and respiratory function and include pulse, blood
pressure, temperature and respiratory rate.

Pulse
The following should be considered when observing the pulse,
- the rate of the pulse
- rhythm
- radiofemoral pulse

Rate - In healthy adults the resting heart rate should be between 60 and 100 beats per
minute. (bpm)
A heart rate of less than 60 pbm is known as Bradycardia
A heart rate of more than 100 pbm is known as Tachycardia

Rhythm – The heart contracts (beats) and pumps blood with a regular rhythm, for
example, at a rate of 60 beats per minute there is a beat every second. The heart may beat
faster or slower with a shorter or longer interval between beats, but at any one rate the
interval between beats is constant. This regular rhythm occurs as a result of regular
electrical discharges (currents) that travel through the heart and cause the muscle of the
heart to contract. In an irregular heart beat, the electrical discharges are irregular and
rapid and, as a result, the heart beats irregularly and, usually, rapidly.

(Some extra notes….

Aortic regurgitation, or anaemia (red blood cell count/hemoglobin count is less than
normal) for example are causes of a large stroke volume and typically produce a
bounding pulse with a wide amplitude.
Aortic stenosis (an abnormal narrowing of the aortic valve) impedes ventricular emptying
and may cause a slow rising, weak and delayed pulse)

Radiofemoral pulse – this is assessed by measuring the radial pulse (felt just medial to the
radius the forefinger and middle finger pulps of hand) and the femoral pulse (found one
third of the way up from the pubic tubercle, situated below the inguinal ligament). The
delay between the two can be reflective of what is happening at the deeper level where
the ductus arteriosus (A key arterial shunt) joins the descending aorta.

Blood Pressure (BP)

In healthy adults,
the Systolic BP falls between 90 & 120mm Hg
the Diastolic BP falls between 60 & 80mm Hg
The blood pressure is measured using a sphygmomanometer and uses a 12.5cm wide cuff
which wraps over the brachial artery (The artery that runs from the shoulder down to the
elbow). For an approximate estimation of the systolic blood pressure the cuff is fully
inflated and then deflated slowly (3-4mmHg per second) until the radial pulse returns.
The pressure at which the sound is first heard is the systolic blood pressure, and the
pressure at which the sound finally disappears is the diastolic blood pressure.
Pressure may vary in the arms and the legs.

Temperature
In healthy adults, the normal temperature ranges between 36.6 C and 37.2 C (98F and
99F). It should be noted that in very hot weather the temperature may rise by 0.5 C. There
is also diurnal variation where the body temperature is lowest in the morning and reaches
its peak between 1800hours and 2000hours. This is relevant as ‘fever-pattern’ (febrile
pattern) of most diseases follows this diurnal variation. The three main areas where
temperature recording are often made are mouth, axilla (the cavity beneath the junction of
the arm and the body) and the rectum. The normal, average temperature of these 3 areas
differs, 36.8 C, 36.4 C and 37.3 C respectively, with an increase of 0.5 C considered to be
an indicator of a fever.

Respiratory Rate
The number of breaths per minute or, more formally, the number of movements
indicative of inspiration and expiration per unit time. In practice, the respiratory rate is
usually determined by counting the number of times the chest rises or falls per minute.
By whatever means, the aim is to determine if the respirations are normal, abnormally
fast (tachypnea), abnormally slow (bradypnea), or nonexistent (apnea)

Glasgow Coma Scale

The assessment of conscious level is an essential part of the neurological examination.
The patients level of arousal and response to stimuli can be graded on the ‘Glasgow
Coma Scale’ (GCS) using a numerical scale which allows for comparison and may
provide prognostic information. The GCS is divided in to 3 categories, and are as
follows.

Eye Opening (E)

- Spontaneous 4
- To speech 3
- To pain 2
- Nil 1

Best Motor Response (M)

- Obeys 6
- Localises 5
- Withdraws 4
- Abnormal flexion 3
- Extensor response 2
- Nil 1

Verbal Response (V)

-Orientated 5
- Confused conversation 4
- Inappropriate words 3
- Incomprehensible sounds 2
- Nil 1

Scores are tallied by the equation

Coma Scale = E + M + V
A score of 15 equates to full consciousness, 12-14 the person may be awake but ‘cloudy’,
scores of 8 or under equate to the person in a coma state. In terms of prognosis, scores of
4 or less generally have a very poor prognosis, and scores of 11 or more have a good
prognosis for recovery.

REVIEW OF FIRST AID ASSESSMENT

(This is all courtesy of the Australian Red Cross)

Basic Life Support Flow Chart

D Check for Danger/Safety (of yourself/victim)

R Check Response to voice/touch/check for signs of life (If no, call 000/112)
A Clear and open the Airway (in position they are in or move to recover position if
more suitable
B Give 2 Breaths if not breathing normally (watch for the chest to rise and fall)
Recheck for signs of life
C Give 30 chest Compressions (compressions made on the sternum using 2 hands –
find the notch where the ribs meet in the centre and compress 1/3 of chest depth)
compressions given at rate of 100 per minute, followed by 2 more breaths
D Defibrillate – attach AED as soon as available

The role of a ‘first-aider’ is to continue with CPR until qualified personnel arrive or signs
of life return. In this context, ‘no signs of life’ is defined as no response (unconscious),
not breathing normally, not moving.

Care is needed when given resuscitation to a child aged between one and eight years and
only hand should be used to give compressions, being aware not to compress to high or
too low. Special care is needed when giving CPR to babies under 1 year of age. Only 2
fingers should be used to give compressions, and the breaths given should be ‘puffs’. The
same steps and principals apply to adults, children and babies, and the same 2/30 ratio
applies to all.
*Pregnant women in their last weeks of pregnancy should have padding put under their
right buttock to tilt her hips left (Left Lateral Tilt) as this allows free movement of blood
back to the heart. When in this position CPR may begin.