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.”9 It was not until the early part of the 20th century, however, that blood pressure determination also became routine. Additional components of the present standard emergency assessment, such as oxygen saturation by pulse oximetry, capillary blood glucose, and pain severity, are sometimes considered vital signs. Although they are essential components of the clinical evaluation and are important considerations throughout this text, they are not discussed in this chapter. Similarly, invasive and noninvasive modalities for the bedside assessment of organ function, such as capnometry, focused ultrasonography, arterial Doppler analysis, arterial catheterization, and tissue oxygen saturation, are not discussed here but appear in relevant sections of this textbook.1
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 used to assess and monitor a patient’s response to 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 in the particular clinical setting. 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 in adults is defined as 96.8° to 100.4°F (35°–38°C), and, although less reliable, a normal oral temperature is considered 95.0° to 99.6°F (36.4°–37.5°C).
TABLE 3–1Normal Vital Signs by Agea ||Download (.pdf) TABLE 3–1 Normal Vital Signs by Agea
|Age ||Systolic BP (mm Hg) ||Diastolic BP (mm Hg) ||Pulse (beats/min) ||Respirations (breaths/min)b |
|Adult ||120 ||80 ||50−90 ||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 |