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THE VITAL SIGNS

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LEARNING OBJECTIVES
DEFINITIONS AND PHYSIOLOGY

PROCEDURES & METHODS OF MEASUREMENT /

ESTIMATION
NORMAL RANGES
ABNORMAL FINDINGS AND RELATED CONDITIONS

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HE LOOKS BAD
BY MEASURING THE VITAL SIGNS ONLY
YOU
CAN HAVE A RELIABLE ASSESSMENT OF
CASUALTYS CURRENT CONDITIONS

YOUR FINDINGS WILL LEAD YOU TO

DECISIONS FOR TREATMENT

FROM THE VITAL SIGNS TREND YOU CAN CHECK

THE EFFECTIVENESS OF INTERVENTIONS AND
FORESEE THE EVOLUTION
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REFERENCES
PRE HOSPITAL TRAUMA LIFE SUPPORT (PHTLS)
MILITARY 7th EDITION 2011 ISBN 978-0-323-06503-0
CHAPTER 6, PP. 113-115
CHAPTER 8, PP. 194-196
CHAPTER 20, PP.479-480

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THE VITAL SIGNS

THEY ARE CALLED VITAL SIGNS BECAUSE THEY GIVE
AN INDICATION OF THE PATIENTS MAIN CONDITIONS
TEMPERATURE
PULSE
BLOOD PRESSURE
RESPIRATION
ANY MARKED DEVIATION FROM THE NORM IS A
DISTRESS SIGNAL FROM THE BODY
CHANGES OVER TIME ARE AS IMPORTANT AS THE
MEASUREMENT ITSELF
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ADDITIONAL SIGNS
TO ASSES THE PATIENTS CONDITION ARE ALSO USEFUL:
CRT CAPILLARY REFILL TIME
SKIN COLORATION (e.g. pale, bluish, waxy or red)
URINE OUTPUT /24h
THE URINE OUTPUT / 24h IS VERY IMPORTANT TO MONITOR ANY
CRITICALLY INJURED PATIENT BUT IT IS BEYOND THE SCOPE OF
THIS COURSE

PULSE OXYMETRY
IT IS BEYOND THE SCOPE OF THIS COURSE

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BODY CORE TEMPERATURE

IS THE RESULT OF A BALANCE BETWEEN
HEAT PRODUCED
HEAT LOST
HYPOTHALAMUS IS RESPONSIBLE FOR THE
REGUALTION BY SPEEDING UP OR SLOWING DOWN
THE CELLS METABOLISM
INCREASE IN METABOLISM = INCREASE IN HEAT
HEAT IS DISTRIBUTED BY BLOOD AND IT IS LOST
THROUGH SKIN, LUNGS, BREATHING, EXCRETIONS
IF BALANCE IS DISTURBED DEVIATIONS IN BODY CORE
TEMPERATURE OCCURS

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NORMAL BODY CORE TEMPERATURE

THE NORMAL AVERAGE BODY CORE TEMPERATURE
FOR MOST PEOPLE IS 37.0 C = 98.4F

THE TEMPERATURE WILL VARY DEPENDING UPON

THE SITE USED TO TAKE THE TEMPERATURE:
RECTAL IS THE MOST ACCURATE
AXILLARY / ORAL CIRCA 1 DEGREE LOWER

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ABNORMAL TEMPERATURE
PYREXIA (FEVER) IS AN ELEVATION ABOVE THE
NORMAL RANGE > 37.8C / 100F (ORAL)
HEAT IS PRODUCED FASTER THAN THE BODY
CAN ELIMINATE IT
FEVER IS A COMMON SYMPTOM OF INFECTION
OR OTHER ILLNESS
HYPOTHERMIA IS A REDUCTION BELOW THE
NORMAL RANGE. < 36.0C / 98.3F, IT MAY BE
CAUSED BY
SHOCK
STARVATION
PROLONGED ILLNESS
OVER EXPOSURE TO THE ENVIRONMENT
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MEASURING TEMPERATURE
THE TEMPERATURE CAN BE MEASURED AT:
THE MOUTH (ORAL)
THE RECTUM (RECTAL)
THE ARMPITS (AXILLARY)
THE METHOD USED WILL DEPEND ON
THE PATIENTS AGE
THE PATIENTS PHYSICAL CONDITION
EQUIPMENT AVAILABLE

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ORAL TEMPERATURE
IS THE MOST CONVENIENT METHOD
USED FOR RESPONSIVE ADULT PATIENTS
IF THE PATIENT HAS HAD FOOD OR DRINK,
OR HAS BEEN SMOKING, WAIT 15 MINUTES
WHEN HANDLING THERMOMETERS, HOLD
ONLY BY THE STEM END

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ORAL TEMPERATURE PROCEDURE

WASH HANDS
CHECK THERMOMETER AND SHAKE DOWN TO <35C
PLACE BULB END UNDER PATIENTS TONGUE
INSTRUCT PATIENT TO CLOSE LIPS AND NOT TO BITE
LEAVE THERMOMETER FOR AT LEAST 3 MINUTES
REMOVE, READ AND RECORD TEMPERATURE
WIPE CLEAN WITH MEDISWAB

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RECTAL TEMPERATURE
IS THE MOST ACCURATE METHOD (*), USED FOR
INFANTS AND YOUNG CHILDREN
UNCONSCIOUS / UNRESPONSIVE ADULTS
SUSPECTED HYPOTHERMIA
DO NOT USE ON PATIENTS WHO HAVE A RECTAL
DISORDER
(*) LATEST RESEARCHES INDICATE THAT THE EAR-DRUM
TEMPERATURE IS THE MOST ACCURATE BUT
ARE
EAR-THERMOMETERS AVAILABLE / USEFUL IN THE FIELD?

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RECTAL TEMPERATURE - PROCEDURE

TURN PATIENT ON HIS SIDE TOP KNEE BENT
EXPOSE BUTTOCK BUT KEEP PATIENTS PRIVACY
SHAKE DOWN
LUBRICATE
EXPOSE ANUS
INSERT BULB SLOWLY ABOUT 3cm ASKING THE
PATIENT TO TAKE A DEEP BREATH
HOLD IN PLACE FOR 2 MIN (YOU DO IT)
REMOVE, READ AND RECORD TEMPERATURE
CLEAN WITH MEDISWAB / USE DISPOSABLE
THERMO COVERS
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AXILLARY TEMPERATURE
USED WHEN TEMPERATURE CANNOT BE TAKEN BY OTHER
METHODS
PROCEDURE:
DRY ARMPIT
PLACE BULB IN CENTRE OF ARMPIT POINTED TOWARD
PATIENTS HEAD
FOLD ARM ACROSS CHEST AND LEAVE FOR AT LEAST 10
MINUTES
REMOVE, READ AND RECORD TEMPERATURE
CLEAN WITH MEDISWAB

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RECORDING TEMPERATURE
ALWAYS USE DECIMALS e.g. 37.1
WRITE THE UNIT Celsius or Fahrenheit e.g. 98.4 F
ALWAYS INDICATE METHOD USED TO TAKE TEMPERATURE e.g. 37.1 C (R) or (O) or (A)

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THERMOMETERS
MOST COMMON TYPES ARE:
ELECTRONIC DIGITAL THERMOMETER
MERCURY FILLED THERMOMETER (BLUE TIP)
OTHER TYPES ARE:
SINGLE-USE CLINICAL THERMOMETER
e.g. 3M TEMPADOT
EAR SCANNING

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LOW READING THERMOMETERS

LOW READING THERMOMETERS ARE AVAILABLE
MERCURY FILLED
USED FOR TAKING AN ACCURATE TEMPERATURE
FROM POSSIBLE HYPOTHERMIC CASUALTY
SCALE RANGES FROM 25C TO 40C
CONSIDER ADDING ONE TO THE MEDIC BAG WHEN
OPERATING IN COLD WET CLIMATES

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THE PULSE
IT IS DEFINED AS THE EXPANSION AND CONTRACTION
OF AN ARTERY CAUSED BY THE HEART BEATING
NORMALLY RHYTHMIC
WHEN THE HEART CONTRACTS BLOOD IS FORCED
INTO THE ARTERIES
THE PULSE WAVE CAUSES AN EXPANSION ALONG
THE ARTERIES
A PULSE IS MEASURED AS AN AID TO DETERMINING
THE PATIENTS CONDITION BY COMPARING IT WITH
NORMAL HEART RATE

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PULSE SITES
THE PULSE CAN BE PALPATED AT POINTS WHERE AN
ARTERY LIES CLOSE TO THE SKIN OR WHERE IT CROSSES
A BONE:
WRIST (RADIAL)
NECK (CAROTID)
GROIN (FEMORAL)
UPPER ARM (BRACHIAL)
INNER ANKLE (POSTERIOR TIBIAL)
TOP OF THE FOOT (DORSALIS PEDIS)

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NORMAL PULSE RATES

THE NORMAL PULSE IS REGULAR IN:
RATE (bpm)
RHYTHM (PAUSES BETWEEN BEATS)
STRENGTH (EXPANSION=VOLUME OF BLOOD), A
STRONG PULSE IS EASILY DETECTED DUE TO
THE LARGE VOLUME OF BLOOD BEING PUMPED
THE AVERAGE RATE IN ADULTS IS BETWEEN 60 - 80
PULSE BEATS PER MINUTE (bpm)
THE ABNORMAL PULSE RATES ARE CALLED
BRADYCARDIA (SLOWER THAN NORMAL)
TACHYCARDIA (FASTER THAN NORMAL)
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BRADYCARDIA
IT IS A PULSE RATE BELOW 60 bpm
PATIENTS WITH HEART DISEASE MAY HAVE A SLOW
HEART RATE DUE TO DRUGS
ATHLETES MAY HAVE A NORMAL PULSE BELOW 60
bpm

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TACHYCARDIA
IT IS A PULSE RATE OVER 100 bpm
PHYSIOLOGICAL CAUSES
EMOTION
EXERCISE
PAIN
PATHOLOGICAL CAUSES
FEVER
SHOCK

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PULSE & BLOOD PRESSURE

THE PULSE CAN BE USED AS A SIMPLE INDICATOR TO
ESTIMATE THE BLOOD PRESSURE, ESPECIALLY IN THE
TRAUMA CASUALTY ASSESSMENT:
RADIAL PULSE PRESENT BP AT LEAST 80 mmHg
FEMORAL PULSE PRESENT BP 70 > < 80 mmHg
CAROTID PULSE PRESENT BP 60 > < 70 mmHg

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THE RADIAL PULSE

IF YOU FEEL IT, THE BLOOD PRESSURE IS

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THE FEMORAL PULSE

IF NO RADIAL BUT YOU FEEL THE FEMORAL PULSE,

THEN THE BLOOD PRESSURE IS
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THE CAROTID PULSE

IF NO RADIAL NEITHER FEMORAL BUT YOU FEEL THE

CAROTID PULSE, THEN THE BLOOD PRESSURE IS
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PROCEDURE
LOCATE THE PULSE POINT
PALPATE THE PULSE BY PLACING THE FIRST 2-3 FINGERS
(NOT THE THUMB) ON THE PULSE POINT

COUNT PULSE FOR A FULL MINUTE (ESPECIALLY IF

HYPOTHERMIA IS SUSPECTED) NOTING RATE, RHYTHM AND
STRENGTH
RECORD

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RESPIRATORY RATE
RESPIRATION IS THE PROCESS BY WHICH O2 AND
CO2 ARE INTERCHANGED BY THE BODY

RESPIRATORY RATES VARY

ACCORDING TO AGE, EXERCISE,
STRESS, EMOTION, PAIN, DRUGS, ETC.

NORMAL RESPIRATORY RATE IS CALLED EUPNEA

12-20 BREATHS/MIN

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NORMAL AVERAGE OF
RESPIRATORY RATES

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PATTERNS OF BREATHING
EUPNEA RELAXED, EFFORTLESS, EVENLY
PACED AND AUTOMATIC
ABNORMAL DYSPNEA, TACHYPNEA,
BRADYPNEA, RESPIRATORY DISTRESS, ETC.
SPECIFIC PATTERNS CHEYNE-STOKES,
KUSSMAUL, ETC.
NOISY REGARD ANY NOISY BREATHING AS
OBSTRUCTED BREATHING

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BLOOD PRESSURE
IT IS DEFINED AS THE PRESSURE EXERTED
BY BLOOD ON THE WALLS OF THE VESSELS
ALL PARTS OF THE VASCULAR SYSTEM
ARE UNDER PRESSURE
BLOOD PRESSURE USUALLY REFERS TO
THE ARTERIAL PRESSURE

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BLOOD PRESSURE
THE BLOOD PRESSURE IS THE PRODUCT OF:
FORCE OF CONTRACTION OF THE VENTRICLES
AMOUNT OF BLOOD PUMPED OUT OF THE HEART
RESISTANCE OF THE BLOOD VESSELS TO THE FLOW OF
BLOOD THROUGH THEM
BY MEASURING THE BLOOD PRESSURE, INFORMATION CAN
BE OBTAINED ABOUT:

THE EFFECTIVENESS OF HEART CONTRACTIONS

THE ADEQUACY OF THE BLOOD VOLUME

THE PRESENCE OF ANY INTERFERENCE

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SYSTOLIC & DIASTOLIC PRESSURE

MEASUREMENTS OF THE BLOOD PRESSURE CONSISTS
OF TWO DIFFERENT VALUES WRITTEN AND RECORDED
AS A FRACTION
SYSTOLIC PRESSURE IS THE LEVEL
PRESENT DURING THE
CONTRACTION OF THE VENTRICLES
DIASTOLIC PRESSURE IS THE LEVEL
DURING THE
RELAXATION OF
THE HEART

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SYSTOLIC & DIASTOLIC PRESSURE

THE BLOOD PRESSURE IN A HEALTHY ADULT IS
AROUND 120/80 MILLIMETRE OF MERCURY
(ABBREVIATED TO mmHg)
120mmHg IS THE NORMAL SYSTOLIC PRESSURE
80mmHg IS THE NORMAL DIASTOLIC PRESSURE
(IN FEMALES IS CONSIDERED NORMAL 110/70mmHg)

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FACTORS INFLUENCING BP
PHYSIOLOGICAL

PATHOLOGICAL

AGE

DRUGS

SEX

DISEASE

BODY BUILD

HEMORRHAGE

EXERCISE

INTER-CRANIAL PRESSURE

PAIN EMOTION

CARDIAC TAMPONADE

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EQUIPMENT
SPHYGMOMANOMETER

STETHOSCOPE

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BLOOD PRESSURE SOUNDS

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SIMPLIFIED BP MEASUREMENT
IN THE BATTELFIELD (TRAUMA/MASS CASUALTY) BP CAN BE ESTIMATED ACCORDING TO THE
PRESENCE OF DIFFERENT PERIPHERAL PULSES (NO EQUIPMENT IS NEEDED FOR THIS IMMEDIATE
APPROACH)
RADIAL PULSE PRESENT BP AT LEAST 80 mmHg
FEMORAL PULSE PRESENT BP 70 > < 80 mmHg
CAROTID PULSE PRESENT BP 60 > < 70 mmHg

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ABNORMALITIES OF BP
HYPERTENSION

DEFINED AS A PERSISTENT HIGH BP > 160/100

mmHg, CAN CAUSE DAMAGE TO THE BRAIN,
INTERNAL ORGAN, THE HEART AND THE RETINA
OF THE EYES
HYPOTENSION

DEFINED AS A PERSISTENT LOW SYSTOLIC BP <

100 mmHg, ASSOCIATED WITH
SYMPTOMS OF SHOCK OR CIRCULATORY
FAILURE IN TRAUMA CASUALTIES
DECREASED CARDIAC OUTPUT

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ADDITIONAL VITAL SIGNS

TO COMPLETE THE ASSESSMENT OF A CASUALTY,
THE MEDIC HAS TO PAY ATTENTION TO THE
FOLLOWING ADDITIONAL VITAL SIGNS AS WELL
CAPILLARY REFILL TIME
SKIN COLORATION

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CAPILLARY REFILL TIME (CRT)

RETURN OF BLOOD WHEN THE FOREHEAD, NAIL BEDS OF
FINGER OR TOE NAILS ARE PRESSED
NORMAL RETURN
WITHIN 1-2 SECONDS

PROLONGED RETURN
INDICATES A SLOW PERFUSION OF NAIL BEDS BECAUSE OF
SEVERE
HYPOVOLEMIC OR HYPOTHERMIC CONDITIONS

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SKIN COLORATION 1/2

TO EVALUATE THE SKIN COLOR IS IMPORTANT
REDNESS OR ERYTHEMA e.g. FEVER, INFLAMMATION, ALLERGIES, HYPERTENSION, HEAT STROKE, BURNS
PALLOR OF BLANCHING SKIN e.g. EMOTIONAL STRESS LIKE FEAR & ANGER, ANEMIA, LOW BLOOD PRESSURE OR
HYPOVOLEMIC SHOCK
JAUNDICE A YELLOWISH SKIN e.g. LIVER DISORDER IN WHICH THE EXTRA AMOUNT OF BILE PIGMENTS IN THE BLOOD IS
ABSORBED BY THE SKIN (ICTERUS OR HEPATITIS)

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SKIN COLORATION 2/2

BRUISES OR BLACK/BLUE MARKS e.g. COAGULATED BLOOD IN TISSUE SPACE, VARICOSIS OR
HEMOPHILIA (BLEEDERS DISEASE)

CYANOSIS e.g. SEVERE BREATHING PROBLEMS AND HEART FAILURES (WHEN HEMOGLOBIN IS POORLY
OXYGENATED, BOTH THE BLOOD AND THE SKIN, ESPECIALLY LIPS AND NAIL BEDS, APPEAR BLUISH)

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THAT BEING SAID

ALL YOUR FINDINGS COMBINED INDICATE
THE CASUALTYS CONDITION
TAKE THE VITAL SIGNS REGULARLY &
RECORD THEM
DO NOT UNDER ESTIMATE THE VITAL SIGNS
TAKE THEM,
TAKE THEM ALL,
AT THE SAME TIME!!!

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