Assessment of Vital Signs and Early Warning Scores

Five aspects of assessing a pulse

Rate, Rhythm, Volume, Character, Equality.

Normal pulse rate for an adult

60-100 beats per minute (bpm).

Radial pulse location

On the radial (thumb) side of the flexor aspect of the forearm, a few centimeters proximal to the wrist.

Tachycardia

A pulse rate greater than 100 bpm, and it can be caused by anxiety, pain, fever, hyperthyroidism, and arrhythmias.

Bradycardia

A pulse rate less than 60 bpm, and it can be caused by fitness, beta blockers, heart blocks, and hypothyroidism.

Atrial fibrillation

An irregularly irregular pulse where the atria quiver instead of beating effectively, and it may cause a pulse deficit.

Coarctation of the aorta detection

Can be detected by a radio-femoral delay, where the femoral pulse is delayed compared to the radial pulse, leading to high blood pressure in the arms and low blood pressure in the legs.

High pulse volume (bounding pulse) causes

Include respiratory failure, fever, pregnancy, exercise, and thyrotoxicosis.

Low pulse volume causes

Can be caused by hypovolemic shock and dehydration.

Pulse characters and their causes

Slow rising (aortic stenosis), collapsing (aortic regurgitation), and pulsus alternans (congestive heart failure).

Normal blood pressure range

A normal blood pressure is around 120/80 mmHg.

Auscultatory gap

A transient disappearance of Korotkov sounds, leading to underestimation of systolic pressure or overestimation of diastolic pressure.

Normal respiratory rate for an adult

12-18 breaths per minute.

Bradypnea

A respiratory rate less than 12 breaths per minute, and it can be caused by opiate overdose, brainstem stroke, or raised intracranial pressure.

Tachypnea

A respiratory rate greater than 18 breaths per minute, and it can be caused by pneumonia, sepsis, asthma, pulmonary embolism, fever, or anxiety.

Normal oxygen saturation level

Normal oxygen saturation is greater than 95%. For patients with chronic obstructive pulmonary disease (COPD), 88-92% can be normal.

Low oxygen saturation causes

Can be caused by pneumonia, pulmonary embolism, chronic smoking, or lung fibrosis.

Normal body temperature for an adult

The normal body temperature is around 37°C (98.6°F), with a fever defined as a temperature above 37.2°C.

Hypothermia

Occurs when body temperature falls below 35°C and can be caused by cold exposure, near drowning, or hypothyroidism.

Hyperthermia or fever

Occurs when body temperature exceeds 37.2°C and can be caused by infection, malignancy, or drug reactions.

Early Warning Score (EWS)

A system used to detect early signs of patient deterioration, using a score to categorize illness severity and trigger nursing staff to request a medical review.

Four color codes used in Early Warning Scores

Red (very bad), Blue (bad), Yellow (warning), White (normal).

Vital signs assessed in the Early Warning Score

The vital signs include pulse rate, blood pressure, respiratory rate, oxygen saturation, and temperature.