General Examination Vital Signs PDF

General Examination Vital Signs DR Ahmed Ali Amer, FRCS, MD References: DR Hoda Abdelhamid internist, DR Rana Toghan physiologist, Lamiaa Abdelsamieh physiologist. Revision: Prof Hossam Ismaeil, internist. ILOS By the end of lecture student should 1. Enum...

General Examination Vital Signs DR Ahmed Ali Amer, FRCS, MD References: DR Hoda Abdelhamid internist, DR Rana Toghan physiologist, Lamiaa Abdelsamieh physiologist. Revision: Prof Hossam Ismaeil, internist. ILOS By the end of lecture student should 1. Enumerate vital signs. 2. Know how to palpate radial pulse 3. Identify comments on radial pulse. 4. Detect arterial blood pressure and know hoe to measure. 5. detect normal value of body temperature and know how to measure. 6. Comment on respiratory rate and know how to measure. 7. Identify normal values of all vital signs What Means Vital???  *The palpable pulse in an artery reflects the pressure wave generated by the ejection of blood into the circulation from the left ventricle. *The pulse is usually determined at the radial artery, brachial, carotid and femoral Other sites?? PULSE Radial artery Brachial artery Femoral artery Sites of peripheral pulsation  How to assess radial pulse?? 1. Hand hygiene. 2. Explain the procedure to the patient 3. Palpate the radial artery using middle 3 fingers with hand semi-flexed semi- pronated 4. Count beats in one minute. 5. Notice rhythm and volume. 6. Check equality and synchronicity with other radial artery. 7. Examine for special character (water hummer pulse, collapsing pulse) (only method for 1st year level postpone explanation ) VIDEO Comment on the following points: (1) Rate. (2) Rhythm. (3) Volume. (4) Equality and synchronicity (5) Special character (water hummer pulse). (6) Condition of the arterial wall. Pulse Radial pulse PULSE (1) Rate: Normal heart rate at mental and physical rest = 60 - 90/minute. (90- 100 high normal) Tachycardia (Rate> 1OO/m) Bradycardia (Rate < 60/m) PULSE (2) Rhythm: (A) Regular rhythm e.g. sinus rhythm tachycardias: (B) Irregular rhythm:* Extrasystole: (3) Volume (amplitude): Volume means the degree of pulsation & reflects the pulse pressure. Normal volume, weak pulse 4) Equality and synchronicity (regarding volume) Causes of inequality: * Thoracic outlet $. * Embolus or thrombus in brachial or radial arteries. (5) special character (water hummer pulse or collapsing pulse). Compress the radial artery by the index then roll the artery under the middle finger after emptying by the index, in young persons the arterial wall is so compliant that you can not feel it, but in old age it is felt as a cord like structure (arteriosclerosis) or as multiple grape like swelling along the course of the artery (PAN). (6) condition of the arterial wall: Arterial blood pressure Second vital sign Blood pressure *BP is a measure of the force that the circulatory blood exerts against the arterial wall. Video pumping blood  ‫جهاز الضغط‬ A) Sphygmomanometer & stethoscope The scientific physical base  B) Digital devices  Less accurate than manual device but average of repeated measurement could be considered  ‫نتيجة القياس‬ Systolic blood pressure ‫البسط‬ Blood pressure: diastolic blood pressure ‫المقام‬ Technique of measurement of blood pressure: Technique of measurement of blood pressure:  Technique of measurement of blood pressure: Measurement of blood pressure: (1) no constricting garments; (2) apply cuff of the appropriate size; (3) palpate brachial pulse before applying stethoscope; (4) support arm at heart level; (5) inflate cuff until radial pulse is impalpable, check systolic pressure by auscultation, deflate slowly until diastolic pressure is reached.  Precautions  The subject should be: 1. Mentally relaxed 2. Physically relaxed 3. Semi setting position  The arm should be: 1. Supported 2. At the level of the heart 3. Exposed tell the shoulder  Technique of measurement of blood pressure: 1. Hand hygiene, explain the procedure and stand on right side of the patient. 2. Put the cuff around the upper arm with its lower edge 3 cm above the elbow.  ~ The width of the cuff is equal to 40% of the arm circumference (about 12 - 14 cm).  ~ The length of the cuff is equal to 80% of the arm circumference (about 25 cm).  ~ Too short or narrow cuff gives false high reading.  ~ A loose cuff gives false high reading.  ~ If the arm is not supported false increase of diastolic blood Pressure about 10 mm Hg.  ~ Making sure that the cuff lies at heart level. If the brachial artery is much below heart level ~ false high pressure  ~ Failure to remove tight clothes from the upper arm gives false low pressure 3. Palpate the radial pulse. Palpatory method 4. Inflate the cuff until the pulse disappears. 5. Deflate the cuff gradually and note the pressure when the radial pulse reappears (systolic blood pressure). Technique of measurement of blood pressure: 6. Feel brachial artery pulsations(medial to biceps tendon), below the lower edge of rubber cuff. 7. Hold the bell of stethoscope lightly over the site of maximal pulsation, but not in contact with the cuff. 8. Inflate the cuff 30 mmHg above systolic blood pressure(measured by palpatory method) Auscultatory 9. Deflate the pressure gradually and listen to krotkoff method sounds. 10. The 1st appearing clear tapping sound (systolic blood pressure) 11. Continue deflation till sound disappearance (diastolic blood pressure) Normal values Hypertension: Arterial hypertension in adult is defined as persistent elevation of diastolic blood pressure> 90 mmHg or systolic > 140 mmHg on at least two subsequent visits. Hypotension: Arterial hypotension in adult is defined as persistent low systolic blood pressure less than 90 mmHg. Temperature Third vital sign Technique of measurement body temperature 1. Sterilize the thermometer in 70% alcohol for at least 20 minutes. 2. We put the thermometer in the mouth under the tongue - axilla - groin - rectum (for 3 minutes in old types of thermometers and 1 minute with the new models) or until we get two successive fixed readings. 1. In axilla (add 1/2 a degree), it is highly inaccurate 2. In rectum (subtract 1/2 a degree). a. Normal temperature is 36.8 ± 0.4`C. b. Fever means temperature> 37.2°C AM or> 37.7 PM. c. Hypothermia means temperature s 35 C. (rectal), it is missed by routine thermometers, it is detected by thermistor. d. Hyperpyrexia means temperature ~ 41°C. Respiratory rate. Fourth vital sign  Respiratory rate: Normal rate 14 – 18 cycle /min. In the newly born it is about 44 and gradually it decrease till maturity. How to count:  In half a minute (count raising and dropping of the chest ) then multiply in 2.  distract the attention of the patient. Tachypnea: rapid rate of respiration as in fever - anemia - exertion - thyrotoxicosis - cardiac insufficiency and pneumonia. Bradypnea: slow breathing e.g. increased I.C.T., excess alcohol or morphia toxicity Pulse Is 70 b/m, average volume, regular rhythm, equal on both sides, without special character, no palpable artery & intact peripheral pulsations. BP 120/70 mmHg Temp. 37.3∙ c RR 18c/min Example: of vital signs comment ‫العناية المركزة‬