Vital Signs, Lung and Heart Examination

Matthew L. Picone MD, MSEdSt. Joseph’s Hospital

Vital Signs

• Heart Rate or Pulse• Respiratory Rate• Temperature• Blood Pressure• Oxygen Saturation-O2 sat

Vital Signs

• Areas of important interest to take the Pulse Rate: Neck-Carotids, Wrist:Radial, Groin-Femoral, Ankle-Posterior Tibialis

• All of these VS are influenced upon each other and react to the change-normally. Example: When your temperature goes up it’s a normal physiologic response to have your RR and HR go up as well.

Vital Sign Changes

• When BP goes down it is normal for the HR go up to in an attempt to compensate.

• Sleep State: All go down to low normal or even abnormal during Deep Sleep State-Stage 4

• Exception-REM state or Dream state-where almost anything can happen with VS

Heart Rate or Pulse

• Normal Ranges• Abnormal Ranges• Abnormal findings that can be

normal and non-concerning

Children’s Normal HR

• Age Heart Rate• Birth 140• 6 mo 130• 1 yr 115• 2 yr 110• 6 yr 103• 8 yr 100• 10 yr 95

Adult Heart Rates

• By Definition: 60-100 beats/min• Below 60 can be normal for many athletes-

runners especially can have HR 40-60.• Some adults have normal HR over 100,

usually 100-110. • If an individual is anxious, just finishing

skiing(exercising) or on certain medications then HR can vary out of the normal range either high or low.

Abnormal HR

• HR >> 125-150b/min• Assess for regularity of rhythm • Patients will sometimes feel nothing,

palpitations. Assess for lightheaded, dizziness and syncope.

• Maneuvers that can slow the HR down• Oxygen is always helpful in this setting

Fight or Flight Response

When our fight or flight response is activated, sequences of nerve cell firing occur and chemicals like adrenaline, noradrenaline and cortisol are released into our bloodstream. These patterns of nerve cell firing and chemical release cause our body to undergo a series of very dramatic changes. Our respiratory rate increases. Blood is shunted away from our digestive tract and directed into our muscles and limbs, which require extra energy and fuel for running and fighting. Our pupils dilate. Our awareness intensifies. Our sight sharpens. Our impulses quicken. Our perception of pain diminishes. Our immune system mobilizes with increased activation. We become prepared—physically and psychologically—for fight or flight. We scan and search our environment, "looking for the enemy."

Fight or Flight

Fight or Flight

Stethoscope Positioning

Stethoscope

Heart Sounds Positioning

Before You Begin

a) Try to create a quiet environment as much as possible. This may be difficult in a busy emergency room or in a room with other patients and their visitors. Eliminate noise by closing the door and turning off any radios or televisions in the room.

b) The patient should be in the proper position for auscultation, i.e. sitting up in bed leaning forward, lying on his/her left side, or supine or at 30 degree elevation on the examining table.

Positioning for Heart Sounds

c) Your stethoscope should be touching the patient's bare skin whenever possible or you may hear rubbing of the patient's clothes against the stethoscope and misinterpret them as abnormal sounds. You may wish to wet the patient's chest hair with a little warm water to decrease the sounds caused by friction of hair against the stethoscope.

d) Always ensure patient comfort. Be considerate and warm the diaphragm of your stethoscope with your hand before auscultation.

Audio Heart Sounds

http://www.easyauscultation.com/heart-sounds.aspx

Listening to the heart in the Right and Left Intercostal space in the Anterior midclavicular line. Followed by left lateral sternal border in the remaining spots

Groups of children Their agesNormal respiratory rates

Newborns and infants Up to 6 months old 30-60 breaths/min

Infants 6 to 12 months old 24-30 breaths/min

Toddlers and children 1 to 5 years old 20-30 breaths/min

Children 6 to 12 years 12-20 breaths/min

Normal pediatric respiratory rate for infants, newborn, toddlers, and children

Adult Respiratory Rates

• Normal: 12-18 breaths/min• Abnormal called Tachypnea >20

br/min• If RR > 24 br/min then look for signs

of distress.• Check O2 Saturation-pulse

oxygenation• Normal O2 saturation: > 92-100%

Abnormally fast RR

• Hyperventilation Syndrome: or rapid RR

• Mental Health Causes: Anxiety or Panic

• Medical Causes: Diabetes out of control(DKA)

• Physiologic Causes: Taking too many deep breaths and increasing rate. Sometimes seen in laboring woman

Hyperventilation Syndrome

• Metabolic Results: Loss of CO2• Physiologic results: Compensatory in

uncontrolled diabetes to blow-off CO2• Physical Symptoms you may see:• Numbness and tingling in face, hands

or feet.• Chest Pains, dizzy, sweaty, confused

and sometimes fainting occurs

Auscultation of Lung Sounds

Respiration

• http://www.easyauscultation.com/heart-sounds.aspx