Vital Signs--What Is Normal?

Most every time you visit the doctor, a nurse checks your vital signs.  When a patient is in the hospital, nurses monitor vital signs frequently, assuming there isn't a machine hooked up to do it for them.  Vital signs not only provide information about the current condition of a patient, but they also provide baseline information for the doctor when the patient is feeling well so that the doctor can see more easily what is off when a patient does not feel well.

Normal vital signs vary by age, as well as by gender and overall health.  This is one reason why maintaining accurate health records is critical for care providers; it helps physicians determine what is normal for any given patient and how to interpret any changes.

	Pulse	Respiration Rate	Systolic Blood Pressure
Newborn	120-180	40-50	60-80
1-2 years	90-120	25-30	90-105
3-10 years	80-100	20-30	100-110
10+ years	<80	<20	100-120

The chart above provides normal ranges of the vital signs of pulse, respiration, and blood pressure for newborns through adults.  The two other vital signs, temperature and oxygen saturation, do not vary by age.  A temperature of 98.6 degrees Fahrenheit is considered normal.  Anything over 100.4 is a fever, and anything below 96.8 is considered hypothermia.  Any temperature over 103 degrees suggests a serious infection, but remember, it's not a perfect correlation.  

While armpit temperature measurements were used for some time, they are not very accurate.  Oral and rectal measurements are much more reliable.  Be sure to have at least one of each.  Glass thermometers are more accurate.  Yeah, you've got to shake them down and it takes a few minutes to get the reading, but having an accurate reading is critical.  Those digital thermometers can vary quite a bit, so they're not my favorite.  

Another vital sign is the oxygen level in the blood.  Measured with a pulse oximeter, it provides information on how well gas exchange in the lungs is proceeding.  Normal is above 95%.  Anything below 94% indicates a need for supplemental oxygen or significant respiratory disease.  

The sicker a patient is, the more the vital signs will deviate from normal.  There are several early warning score options; they are all pretty similar.  They are useful for determining trends in patients, whether the patient is getting worse or better.  It's a tool to use in conjunction with other observations. 

The NHS Early Warning Score (NEWS) comes to us from the United Kingdom.  The system assigns a point value to abnormal vital signs.  The point total from all signs gives an indication of how sick a patient is.

 

0-4 points	The patient is not likely to be seriously ill at the moment.
5-7 points, or a single vital sign of three points	The patient may be quite ill.  Monitor closely.
>7 points	The patient is seriously ill and needs licensed medical care.

NHS Early Warning Score
	3	2	1	0	1	2	3
Temperature	<95		95.1-96.8	96.9-100.4	100.5-102.2	>102.3
Respiration rate	<8		9-11	12-20		21-24	>25
Pulse	<40		41-50	51-90	91-110	111-130	>131
Oxygen saturation	<91	92-93	94-95	>96			>220
Systolic blood pressure	<90	91-100	101-110	111-219
Consciousness level (AVPU)				A			V, P, or U

Links to related posts:
Assessing a Patient
Taking and Giving a Patient History  

For further information:
Survival and Austere Medicine, 3rd Edition, pp 68-71
https://www.mdcalc.com/national-early-warning-score-news

23 june 2020