Workshop: Physiological Basis of Clinincal Assessment of Vital Signs

Question 1

What is the need to record clinical vital signs?

Answer 1

They are easy to perform and may be extremely valuable to assess patients or monitor their deterioration.
The need and frequency for monitoring clinical vital signs depends on individual patient presentation.
Monitoring of clinical vital signs may need to be supplements by special investigations such as blood tests and x-rays.

Question 2

When assessing patients what are the 2 things not to forget?

Answer 2

Ask them how they feel: e.g. well, unwell, dizzy, cold, hot etc.
Observe how they look: well, unwell, pale, flushed, etc.

Question 3

What to look for when taking pulse?

Answer 3

Rate beats/min (normal, fast or slow). Also rhythm (regular or irregular), volume (e.g. good volume or weak).

Question 4

What to look for when taking blood pressure?

Answer 4

Normal, high or low. Also, not calculated values such as pulse pressure and MAP.

Question 5

What to look for when taking temperature?

Answer 5

Normal, high or low

Question 6

What to look for when measuring respiratory rate?

Answer 6

breaths/min (normal, fast or slow).

Question 7

What to look for when measuring capillary refill time?

Answer 7

Normal or prolonged.

Question 8

What to look for when measuring oxygen saturation?

Answer 8

Normal or low

Question 9

What to look for when measuring consciousness?

Answer 9

Use AVPU
Aware
Voice
Pain
Unresponsive

Question 10

When comparing recording vital signs to normal values use a NEWS chart. what do you have to remember?

Answer 10

Clinical concern should always override any scores.

Question 11

What is pulse pressure?

Answer 11

It is the difference between systolic arterial and diastolic arterial blood pressures.

Question 12

Are the heart and blood vessels effectors?

Answer 12

Yes

Question 13

If the mean arterial blood pressure decreases, what happens?

Answer 13

Vasoconstriction is caused by increased sympathetic activity.

Question 14

A fit and healthy 24 year-old butcher is boning a leg of lamb with a sharp knife. The knife slips and he sustains a deep laceration to his left groin. There is a large amount of bleeding ?cut major vessel in his left groin. His colleague applies pressure to the area with a clean cloth and calls for an ambulance.

He feels dizzy and slightly breathless.
Examination: He looks pale. His skin feels cool and clammy.
Pulse: 120 beats/min regular, weak.
Blood Pressure: 90/65 mm Hg
Capillary Refill Time: 4 seconds
Respiratory rate: 26/min
Oxygen Saturation: 96% (on air)
Temperature: 36.7oC

He feels dizzy and slightly breathless. Why is that?

Answer 14

Dizzy - Low arterial blood pressure as a result of blood loss - brain not getting normal perfusion and oxygenation. This can progress to confusion, lethargy and loss of consciousness with more blood loss.

Breathless - Body trying to supply more oxygen to tissues

Question 15

A fit and healthy 24 year-old butcher is boning a leg of lamb with a sharp knife. The knife slips and he sustains a deep laceration to his left groin. There is a large amount of bleeding ?cut major vessel in his left groin. His colleague applies pressure to the area with a clean cloth and calls for an ambulance.

He feels dizzy and slightly breathless.
Examination: He looks pale. His skin feels cool and clammy.
Pulse: 120 beats/min regular, weak.
Blood Pressure: 90/65 mm Hg
Capillary Refill Time: 4 seconds
Respiratory rate: 26/min
Oxygen Saturation: 96% (on air)
Temperature: 36.7oC

He looks pale. His skin feels cool and clammy. Why is that?

Answer 15

Arterial blood pressure decreases as a result of blood loss, low arterial blood pressure detected by baroreceptors, resulting in sympathetic stimulation and peripheral vasoconstriction.

This helps raise systemic vascular resistance (SVR) and hence fight the drop in blood pressure.

Question 16

A fit and healthy 24 year-old butcher is boning a leg of lamb with a sharp knife. The knife slips and he sustains a deep laceration to his left groin. There is a large amount of bleeding ?cut major vessel in his left groin. His colleague applies pressure to the area with a clean cloth and calls for an ambulance.

He feels dizzy and slightly breathless.
Examination: He looks pale. His skin feels cool and clammy.
Pulse: 120 beats/min regular, weak.
Blood Pressure: 90/65 mm Hg
Capillary Refill Time: 4 seconds
Respiratory rate: 26/min
Oxygen Saturation: 96% (on air)
Temperature: 36.7oC

Comment on the pulse. Which underlying mechanisms cause this?

Answer 16

Pulse is rapid (tachycardia) and weak.

Arterial blood pressure decreases as a result of blood loss, low arterial blood pressure detected by baroreceptors, resulting in increased sympathetic and decreased parasympathetic activity to the heart - both of these increase heart rate. The pulse is weak due to loss of blood volume resulting in low stroke volume.

Question 17

What is the fashion of blood flow in normal arteries?

Answer 17

Laminar fashion. Such laminar flow is not audible through a stethoscope - no sounds is heard in a normal patient artery.

Question 18

How can you use cuff sphygmomanometer and stethoscope to estimate arterial blood pressure?

Answer 18

If external pressure (e.g. cuff pressure) exceeding the systolic blood pressure is applied to an artery; the flow in that artery would be blocked and no sound is heard through a stethoscope.
However, if the external pressure is kept between systolic and diastolic pressure the flow become turbulent whenever blood pressure exceeds cuff pressure.

Question 19

A fit and healthy 24 year-old butcher is boning a leg of lamb with a sharp knife. The knife slips and he sustains a deep laceration to his left groin. There is a large amount of bleeding ?cut major vessel in his left groin. His colleague applies pressure to the area with a clean cloth and calls for an ambulance.

He feels dizzy and slightly breathless.
Examination: He looks pale. His skin feels cool and clammy.
Pulse: 120 beats/min regular, weak.
Blood Pressure: 90/65 mm Hg
Capillary Refill Time: 4 seconds
Respiratory rate: 26/min
Oxygen Saturation: 96% (on air)
Temperature: 36.7oC

Comment on blood pressure?
Calculate pulse pressure and comment on this?
Calculate mean arterial blood pressure?

Answer 19

Blood pressure in the lower side. Likely to have dropped from what was nrmal for this patient.
Pulse pressure = 90-65 = 25mmHg. Decreased pulse pressure
MABP = DBP + 1/3rd of pulse pressure = 65 + 25/3 = 65 + 8.3 = 73.3 mmHg.

Question 20

What happens during a fever?

Answer 20

In fever, a cold response raises the body temperature to a new set point.

Question 21

Jane is a 25 year-old woman who is normally fit and well with no medical history. She presents to her GP with a 2 day history of feeling hot and shivery, poor appetite and nauseated but no vomiting. She has also noted urinary frequency and discomfort on passing urine; her urine is darker than normal and has a foul smell.

Examination: She looks flushed. Her skin feels warm
Pulse: 110 beats/min regular, of good volume.
Blood Pressure: 110/70 mmHg
Capillary Refill Time: <2 seconds
Respiratory rate: 20/min
Oxygen Saturation: 98% (on air)
Temperature 38.8oC
She looks flushed. Her skin feels warm. Why is this?

Answer 21

Her actual temperature is high at 38.8
Body initiates a warmth response resulting in vasodilation of skin arterioles to increase heat loss.
Hence the patient is flushed with a warm skin.