For more than 200 years, American health care providers have attempted to standardize their approach to the assessment of patients. At the New York Hospital in 1865, pulse rate, respiratory rate, and temperature were incorporated into the bedside chart and called “vital signs.”6 It was not until the early part of the 20th century, however, that blood pressure determination also became routine. Additional components of the standard emergency assessment, such as oxygen saturation by pulse oximetry, capillary blood glucose, and pain severity, are now also beginning to be considered vital signs. Although assessment of oxygen saturation, capillary glucose, and pain severity are essential components of the clinical evaluation and are important considerations throughout this text, they are not discussed in this chapter.
In the practice of medical toxicology, vital signs play an important role beyond assessing and monitoring the overall status of a patient because they frequently provide valuable physiologic clues to the toxicologic etiology and severity of an illness. The vital signs also are a valuable parameter, which are used to assess and monitor a patient’s response to supportive treatment and antidotal therapy.
Table 3–1 presents the normal vital signs for various age groups. However, this broad range of values considered normal should serve merely as a guide. Only a complete assessment of a patient can determine whether or not a particular vital sign is truly clinically normal. This table of normal vital signs is useful in assessing children because normal values for children vary considerably with age, and knowing the range of normal variation is essential. Normal rectal temperature is defined as 95° to 100.4°F (35°–38°C).
++ Table Graphic Jump Location TABLE 3–1.Normal Vital Signs by Agea,b ||Download (.pdf) TABLE 3–1. Normal Vital Signs by Agea,b
|Age ||Systolic BP (mm Hg) ||Diastolic BP (mm Hg) ||Pulse (beats/min) ||Respirations (breaths/min)b |
|Adult ||≤120 ||<80 ||60−100 ||16−24 |
|16 years ||≤120 ||<80 ||80 ||16−30 |
|12 years ||119 ||76 ||85 ||16−30 |
|10 years ||115 ||74 ||90 ||16−30 |
|6 years ||107 ||69 ||100 ||20−30 |
|4 years ||104 ||65 ||110 ||20−30 |
|4 months ||90 ||50 ||145 ||30−35 |
|2 months ||85 ||50 ||145 ||30−35 |
|Newborn ||65 ||50 ||145 ||35−40 |
The difficulty in defining what constitutes “normal” vital signs in an emergency setting is inadequately addressed and may prove to be an impossible undertaking. Published normal values may have little relevance for an acutely ill or anxious patient in the emergency setting, yet ...