Vital Sign Assessment

Amit Sapra; Ahmad Malik; Priyanka Bhandari. https://www.ncbi.nlm.nih.gov/books/NBK553213/

Last Update: May 23, 2020.

Vital signs are an objective measurement for the essential physiological functions of a living organism. 

 They have the name “vital” as their measurement and assessment is the critical first step for any clinic evaluation. The first set of clinical examinations is an evaluation of the vital signs of the patient. The basis of patient triage in an urgent care /prompt care or an emergency room is on their vital signs as it tells the physician the degree of derangement that is happening from the baseline. Healthcare providers must understand the various physiologic and pathologic processes affecting these sets of measurements and their proper interpretation. If we use a triage method where we select patients without determining their vital signs, it may not give us a reflection of the urgency of the patient’s presentation.[1] The degree of vital sign abnormalities may also predict the long-term patient health outcomes, return emergency room visits, and frequency of readmission to hospitals, and utilization of healthcare resources. 

Traditionally the vital signs consist of temperature, pulse rate, blood pressure, and respiratory rate.……It seems intuitive that the higher the frequency of vital sign measurement, the faster the chances of clinical deterioration are detected.

Talking of importance of respiratory rate: There can be a decrease in response to changes in the oxygen and carbon-di-oxide at the molecular level along with anatomical changes resulting due to stiffness of muscles and compliance of the chest wall. Respiratory rate sometimes might be the most neglected of the vital signs reported in hospitalized patients but is more sensitive than other vital signs in picking up a critically ill patient.

Accurately measuring vital signs is a clinical skill that needs time and practice to refine. A review of literature is abundant about the inter-observer variability observed and reported secondary to lack of this skill. Clinicians should be wary of this and always re-check the vital signs themselves if there is a profound or unexpected change.

Adequate acid base balance of the blood requires normal physiological conditions. We know nothing about acid base balance in the serious mental illnesses such as bipolar illness or schizophrenia, even though the symptoms of serious mental illness and metabolic acid base imbalance are the same; all result in mental confused states which can be chronic.

Adequate monitoring and evaluation of basic vital signs, including baseline respiratory rates are ignored in serious mental illness, so we cannot know if physiology is normal in these patients.

J’accuse ….all doctors of not doing a proper basic physical assessment of these and other [neurological] patients due to ignorance of acid base disturbance of the blood and the possibility of broken feedback systems making such control complicated.

I think that studies are needed on unmedicated bipolar patients during depressive, mixed and manic stages, in order to know more about their physiology vis a vis simple vital signs [especially respiratory rate, depth, minute ventilation and pattern] because of their importance in cases of altered mental status and altered mood and altered motor activity and altered motor speed of speech and activity.

It seems intuitive, yet…..