Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care

Measuring the temperature, pulse, respiratory rate (RR), blood pressure, and pulse oximetry is generally recommended for all emergency department (ED) patients, in addition to assessment of pain in the appropriate patient population. For very minor problems or for some fast-track patients (e.g., suture removal), a full set of vital signs may not be required, and this is best decided on a case-by-case basis rather than by strict protocol. Vital signs may indicate the severity of illness and also dictate the urgency of intervention. Although a single set of abnormal values suggests pathology, findings on triage or the initial vital signs may be spurious and simply related to stress, anxiety, pain, or fear. It would be incorrect and not standard of care to attribute initial triage blood pressure, RR, or pulse rate to specific pathology or to retrospectively assume that diagnostic or treatment interventions should have been initiated based solely on these readings. The greatest utility of vital signs is in their continued observation and trends over time. Deteriorating vital signs are an important indicator of a compromised physiologic condition, and improving values provide reassurance that the patient may be responding to therapy. When a patient undergoes treatment over an extended period, it is essential that the vital signs be repeated as appropriate to the clinical scenario, particularly those that were previously abnormal. In some clinical circumstances, it is advisable to monitor the vital signs continuously.

Vital signs should be measured and recorded at intervals as dictated by clinical judgment, the patient’s clinical state, or after any significant change in these parameters. Adhering to strict protocols or disease categories is not useful or productive. An abnormal vital sign may constitute the patient’s entire complaint, as in a febrile infant, or it may be the only indication of the potential for serious illness, as in a patient with resting tachycardia.