Pulse Rate

• Definition: The number of times the heart beats per minute.

• Components of Measurement:

  • Rate

  • Rhythm

  • Volume/Character

• Normal Adult Range: 60 bpm - 100 bpm

• Tachycardia: Fast pulse rate > 100 bpm

• Bradycardia: Slow pulse rate < 60 bpm

Pulse Rate Locations

• Measured at points where arteries are superficial or over a bone; common sites include:

  • Radial Artery

  • Paediatric Sites: Brachial or femoral arteries

Advanced Trauma Life Support Guidelines

• Predicts systolic blood pressure based on palpable pulses:

  • If only the carotid pulse is palpable: Systolic blood pressure is 60-70 mm Hg.

  • If carotid and femoral pulses are palpable: Systolic blood pressure is 70-80 mm Hg.

  • If the radial pulse is also palpable: Systolic blood pressure is > 80 mm Hg.

• Study findings indicate non-invasive measurements tend to underestimate blood pressure during hypotension, suggesting a need for caution in clinical decisions based on these guidelines.

Respiratory Rate

• Definition: The number of breaths taken in one minute, representing ventilation (movement of air in and out of the lungs).

• Measurement Method:

  • Inspect the patient's chest and abdomen, noting movement and accessory muscle use.

  • Factors to assess include:

  1. Chest symmetry

  2. Chest and abdominal movement

  3. Depth of chest movement

  4. Accessory muscle use

  5. Rhythm

Auscultation for Breath Sounds

• Technique:

  • Auscultate from side to side and top to bottom, omitting scapular areas.

  • Key locations include:

  • Apex of Lungs: 2 cm superior to medial 1/3 of clavicle

  • Superior Lobes:

    • Anterior: 2nd intercostal space mid-clavicular line

    • Posterior: Between C7 & T3

  • Inferior Lobes:

    • Anterior: 6th intercostal mid-axillary line

    • Posterior: Between T3 & T10

  • Middle Lobe: Right anterior only (4th intercostal space mid-clavicular line)

Blood Pressure

• Definition: The force exerted against the walls of blood vessels by the blood within.

• Measurement: Based on turbulent blood flow through arteries, impacted by cardiac output and peripheral resistance.

• Normal Ranges:

  • Systolic: 120 - 139 mmHg

  • Diastolic: 80 - 90 mmHg

• Hypertension:

  • Systolic ≥ 140 mmHg

  • Diastolic ≥ 90 mmHg

• Hypotension: Systolic < 90 mmHg

Equipment for Blood Pressure Measurement

• Components:

  • Inflatable cuff

  • Pressure gauge

  • Stethoscope

• Korotkoff Sounds: Generated by pulsatile blood flow through a compressed artery when sound is audible through the stethoscope.

Oxygen Saturations (SpO2)

• Definition: The percentage of hemoglobin that is oxygen-saturated.

• Measurement Tool: Pulse oximeter.

• Normal SpO2 Range: > 94-98%

• Influencing Factors:

  • Poor perfusion

  • Carbon monoxide presence

  • Medications (e.g., vasoconstrictors)

  • Excess movement/artifacts

  • Ambient light levels

  • Hypothermia (cold hands)

  • Nail polish

• Thresholds for Intervention:

  • < 94% or < 88% in respiratory patients requires oxygen therapy.

The Pleth Wave

• Relevance: The waveform must coincide with the patient's pulse and/or ECG rhythm for an accurate SpO2 reading.

• Poor Waveform: Indicates potentially inaccurate reading.

Reliability of SpO2 Readings

• Requirements for a reliable reading:

  1. Good sensor site

  2. Adequate perfusion to that site

  3. Appropriate sensor use

  4. Visible, well-defined waveform to assess reading quality

Capillary Refill Time (CRT)

• Definition: The time required for a pressure-blanched skin site to return to normal color (reperfusion).

• Measurement Method: Apply pressure for 5 seconds until the nail bed turns white; monitor time for reperfusion.

• Normal CRT: < 2 seconds for reperfusion.

• Limitations: CRT may not be universally indicative of perfusion status.

Tympanic Temperature

• Importance: Accurate measurement assists in diagnosis and identifying reversible causes in cardiac arrest.

• Measurement Location: Ear (tympanic), but can also be taken at the axilla or orally when equipment allows.

• Normal Range: 36.1°C – 38.0°C (dependent on the measurement location).

Capillary Blood Glucose (CBG)

• Definition: Measurement of glucose concentration in blood.

• Equipment: Originally developed by Boehringer Mannheim.

• Indications: Used for known diabetics or during unconsciousness/sepsis evaluation.

• Normal Range: 4-7 mmol/L.

Peak Expiratory Flow Rate (PEFR)

• Definition: The volume of air forcefully expelled from the lungs in one quick exhalation, indicating ventilation capacity and airflow obstruction.

• Measurement Tool: Handheld peak flow meters.

• Severity Classification (as per table from the British Thoracic Society):

  • Mild/Moderate: PEFR > 50-75% of best or predicted

  • Acute Severe: PEFR 33-50% of best or predicted

  • Life-Threatening: PEFR <33% of best or predicted

BEFAST Stroke Assessment Tool

• Components:

  • Balance

  • Eyes

  • Face

  • Arm

  • Speech

  • Time (recognition of symptoms)

• Assessment Logic: If one or more elements are abnormal, the patient is deemed 'BEFAST positive'; otherwise deemed 'BEFAST negative'.

Pupil Response Assessment

• Importance: Provides insights into brain function and neurological status.

• Measured Factors:

  • Response to light

  • Diameter (in mm)

  • Average pupil size: 3 - 4 mm

  • Dilated pupils: ≥ 5 mm (Mydriasis)

  • Constricted pupils: ≤ 2 mm (Miosis)

  • Should be equal and reactive to light (PEARL)

AcVPU Scale

• Usage: Assesses level of consciousness as an indicator of underlying problems.

• Components:

  • Alert

  • Voice

  • Pain

  • Unresponsive

Glasgow Coma Scale (GCS)

• Purpose: Measures consciousness level, particularly in brain injury scenarios.

• Score Range:

  • Highest score: 15 (Fully Alert & Oriented)

  • Lowest score: 3 (Unresponsive)

Electrocardiogram (ECG)

• 3-Lead ECG Placement:

  • Limb Leads:

  • RA: Upper Right Arm

  • LA: Upper Left Arm

  • RL: Lower Right Leg

  • LL: Lower Left Leg

• Chest Leads:

  • V1: 4th intercostal space, right of sternum

  • V2: 4th intercostal space, left of sternum

  • V3: Between V2 and V4

  • V4: 5th intercostal space, midclavicular line

  • V5: At left anterior axillary line level with V4

  • V6: Mid-axillary line level with V4.

ECG Tracing and Heart Rate

• Normal Heart Rate:

  • Adult: 60-100 bpm

  • Paediatrics: Increased pulse rate, varies by age

• Tachycardia: Fast pulse rate (> 100 bpm)

• Bradycardia: Slow pulse rate (< 60 bpm)

Important Note on Vital Signs Observation

• Observation Importance: Significant disturbances rarely occur in isolation; evaluating multiple parameters and trends is crucial.

• Baseline Values: Abnormal baseline values may be normal for patients depending on their medical history.