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Vital Sign

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Vital Sign, Abnormal Vital Signs

  • See Also
  1. Blood Pressure
  2. Orthostatic Blood Pressure
  3. Heart Rate
  4. Respiratory Rate
  5. Body Temperature
  6. Fever
  7. Oxygen Saturation
  8. Pediatric Vital Signs
  9. Pediatric Assessment Triangle
  10. Broselow Tape
  • Precautions
  • Abnormal Vital Signs
  1. Unaddressed Abnormal Vital Signs (e.g. abnormal or unrepeated at discharge) are associated with serious adverse outcomes
    1. Likelihood of poor outcome correlates with the specific Vital Sign, number and severity of the abnormality
    2. Persistently abnormal vitals signs (esp. Tachycardia and Hypotension) are at the highest risk of adverse outcome
    3. Unaddressed Abnormal Vital Signs are commonly cited in Malpractice suits
  2. Approach to Abnormal Vital Signs to avoid preventable errors
    1. Review nursing notes and Vital Signs throughout the clinical encounter
    2. Repeat and review Vital Signs at discharge
    3. Explain Abnormal Vital Signs in the context of symptoms and chief complaint prior to discharge
      1. Also consider differential diagnosis
      2. Exercise caution when Vital Sign changes are out of proportion to what would be routinely expected
    4. Arrange close interval follow-up for patients considered safe for discharge
      1. Consider hospital admission or observation for persistent abnormalities, multiple comorbities, higher risk
  3. References
    1. Carlson and Long (2023) Abnormal Vital Signs in Adults at Discharge, EM:Rap, accessed 8/2/2023
    2. Gabayan (2017) Acad Emerg Med 24(7):846-54 +PMID: 28375565 [PubMed]
    3. Hoang (2021) CJEM 23(6): 767-71 +PMID: 34586622 [PubMed]
    4. Nguyen (2017) J Gen Intern Med 32(1):42-8 +PMID: 27503438 [PubMed]
    5. Sklar (2007) Ann Emerg Med 49(6): 735-45 +PMID:17210204 [PubMed]
  • Precautions
  • Specific Measures
  1. Automatic Blood Pressure cuffs may be unreliable
    1. Check manual Blood Pressure for outlying values (esp. shock, Narrow Pulse Pressure, Severe Hypertension)
  2. Oxygen Saturation may be unreliable (e.g. shock state, nail polish)
  • Evaluation
  • Abnormal Criteria
  1. See Pediatric Vital Signs
  2. Adults (18 to 65 years old)
    1. Heart Rate >100
    2. Systolic Blood Pressure <90 mmHg
    3. Temperature >100.4 F (38 C)
  3. Older Adults (>65 years, proposed changes to Emergency Severity Index)
    1. Heart Rate >90
    2. Systolic Blood Pressure <110 mmHg
    3. Temperature >99.3 F (37.4 C)