Changes in vital signs

Introduction Vital signs are indicators used to determine the severity and criticality of a patient's condition. There are mainly heart rate, pulse, blood pressure, breathing, pupil and corneal reflex changes. The four major signs of life include breathing, body temperature, pulse, and blood pressure, which are medically known as the four major signs. They are the backbone of the normal activities of the body. They are indispensable. No matter which abnormality can cause serious or fatal diseases, some diseases can also cause changes or deterioration of these four major signs. Therefore, how to judge their normality and abnormality has become a necessary knowledge and technology for everyone.

Cause

At the same time, certain diseases can also cause changes or deterioration of these four major signs. At the same time, in some cases, their gradual normality also represents the improvement of the disease, indicating that the crisis has changed. If the heartbeat suddenly stops, there will be symptoms such as loss of consciousness and no blood pressure, which means that the patient is transferred to safety. After the rescue, the patient gradually returns to normal. In short, the emergency personnel outside the hospital carefully observe the four major signs of life and make correct judgments, which is conducive to discovery. The safety of the disease and targeted rescue measures. A large number of experimental studies and clinical confirmations have shown that after the heartbeat is arrested by various injury factors, the breathing is terminated and the brain tissue undergoes irreversible damage. Dizziness occurs in 3 seconds after the heartbeat stops; wrong sputum occurs in 10 to 20 seconds, blood pressure drops; twitching occurs in 40 seconds, the pulse is not touched; after 60 seconds of respiratory arrest, incontinence, body temperature drops, and so on End of life, etc. It can be seen that the four vital signs of breathing, pulse, body temperature and blood pressure, under normal circumstances, coordinate with each other, cooperate with each other, and play a role in maintaining normal physiological activities of the human body to maintain life; in the case of abnormal human body, they also interact with each other. Impact, mutual destruction, followed by dangerous syndromes, even life-threatening.

an examination

Related inspection

Body temperature measurement, respiratory exercise, pulse blood pressure, dynamic blood pressure monitoring (ABPM)

When the normal person is in a quiet state, the pulse is 60-100 beats/min (generally 70-80 beats/min). Heart rate and pulse are significantly accelerated when there are signs of heart failure, shock, high fever, severe anemia and pain, thyroid crisis, myocarditis, and atropine. When the intracranial pressure is increased and complete atrioventricular block is blocked, the pulse is slowed down. In general, the heart rate is consistent with the pulse, but in arrhythmias such as atrial fibrillation and frequent premature beats, the pulse will be less than the heart rate, called the short pulse.

Blood pressure (referring to radial artery pressure) is one of the important indicators for measuring cardiovascular function. When both systolic and diastolic blood pressures are below the lower limit of normal (90/60 mm Hg), consideration may be given to acute peripheral circulatory failure, cardiac infarction, heart failure, and acute pericardial tamponade. When hypertensive encephalopathy or increased intracranial pressure, blood pressure is often above 200/120 mm Hg.

Normal people breathe evenly when they are quiet, 12-20 times a minute. If it exceeds 20 beats / min, it is a breathing rate, such as in severe lung disease, heart failure, high fever, anemia. Less than 12 beats / min, known as hypopnea, is common in sleeping pills poisoning and increased intracranial pressure. When people practice qigong, their breathing is profoundly deep, sometimes at 12 times/min. At this time, it is not only a normal phenomenon, but also a strict performance of qigong training. The normal person's breathing rate should be moderately shallow.

The normal pupil has a diameter of 2-4 mm under normal light, and the sides are equally round. When morphine, organic phosphorus and chloral hydrate are poisoned, the pupil shrinks; when ephedrine or atropine is poisoned, the pupil is dilated; brain tumor or tuberculous meningitis and other intracranial diseases, the size of the two pupils varies. The disappearance of bilateral pupil dilation to the photoreaction is a sign of critical illness. The pupil reflection has light reflection, adjusted reflection, and pupil-skin reflection. In pathological conditions, brain dysfunction can make the regulation of reflexes slow or disappear. When the midbrain is damaged, the light is reflexed and the reflex is normal.

Corneal reflex refers to the stimulation of the cornea, causing a reflection of the blink, mainly reflecting the functional state of the bridge. When the patient is dying, the corneal reflex is weakened, the lesion has invaded the pons, and the medulla is about to be invaded, which is a sign of the dying of life.

Differential diagnosis

Differential diagnosis of changes in vital signs:

First, body temperature

The normal body temperature of a person is relatively constant, but it will change due to various factors, but the change has a certain regularity.

(1) Normal temperature and measurement method

1. Oral test method: first use 75% alcohol to disinfect the thermometer, put it under the tongue, close the lips, put it for 5 minutes and take out the reading, the normal value is 36.3~37.2 °C. This law is banned from unconscious patients and infants. The paralyzed patient can't use the tooth bite thermometer, only the upper and lower lips are tight, can't talk, prevent the bite from breaking and the prolapse.

2. Test method: This method is not easy to cross infection, it is the most common method for measuring body temperature. Wipe the armpit sweat, place the mercury end of the thermometer on the top of the armpit, and clamp it with the upper arm half thermometer. The patient can't move. After 10 minutes, the normal value is 36~37 °C.

3. Anal test: used for coma patients or children. The patient was placed in a supine position. After the anal head was lubricated with oil, it was slowly inserted into the anus and reached 1/2 of the anus. After 5 minutes, the reading was made. The normal value was 36.5 to 37.7 °C.

Normal people's body temperature fluctuates slightly within 24 hours, and generally does not exceed 1 °C. Under physiological conditions, the morning is slightly lower, slightly higher in the afternoon or after exercise and after eating. The temperature of the elderly is slightly lower, and women are slightly higher before or during pregnancy.

(two) abnormal body temperature

1. Increased body temperature: 37.4 ~ 38 ° C for low heat, 38.1 ~ 39 ° C for moderate heat, 39.1 ~ 41 ° C for high heat, above 41 ° C for ultra high heat. Increased body temperature is more common in tuberculosis, bacterial dysentery, bronchial pneumonia, encephalitis, malaria, hyperthyroidism, heat stroke, influenza and traumatic infections.

2. Lower body temperature: seen in shock, major bleeding, chronic wasting disease, frail elderly, hypothyroidism, severe malnutrition, exposure to low temperatures in the environment for too long.

Second, the pulse

When the heart is diastolic, the arterial wall is rhythmically and periodically undulating and called the pulse. Check the pulse usually with the radial artery on both sides. The number of normal pulse pulses is consistent with the number of heartbeats, the rhythm is uniform, and the intervals are equal. During the day, due to various activities, the blood circulation is accelerated, so the pulse is faster, the night activity is less, and the pulse is slower. Infants 130-150 beats / min, children 110 ~ 120 beats / min, normal adults 60 ~ 100 beats / min, the elderly can be as slow as 55 ~ 75 beats / min, newborns can be as fast as 120 ~ 140 beats / min.

(a) common abnormal pulse

1. Pulse increase (100 beats / min): physical conditions are emotional, nervous, strenuous physical activity (such as running, climbing, climbing stairs, heavy objects, etc.), hot climate, after meals, after drinking. Pathological conditions include fever, anemia, heart failure, arrhythmia, shock, hyperthyroidism and so on.

2. Pulse slowdown ( 60 beats / min): increased intracranial pressure, obstructive jaundice, hypothyroidism and so on.

3. The pulse disappears (ie, the pulse cannot be touched): more common in patients with severe shock, multiple arteritis, occlusive vasculitis, and severe coma.

(two) pulse counting method

1. Direct measurement: the most common choice is the pulsation of the radial artery. Let the patient rest quietly for 5 to 10 minutes, put the hand in the proper position, and sit down. The examiner puts the index finger, middle finger and ring finger of the right hand in the radial artery of the wrist of the patient. The pressure is preferably pulsating with a clear artery. The pulse rate is several and a half minutes, and multiplied by 2 to get the pulse rate of 1 minute. . The following arteries can also be used when the brachial artery is inconvenient to measure the pulse:

The carotid artery is located between the trachea and the sternocleidomastoid muscle.

Radial artery - located in the medial groove of the biceps brachii on the medial side of the arm.

Femoral artery - the upper end of the thigh, a strong beat point slightly below the midpoint of the groin.

2. Indirect measurement: measurement with pulse oximeter and blood pressure pulse monitor. See the instrument manual for the specific method of use.

Third, breathing

Breathing is the activity of the respiratory tract and lungs. The human body breathes in oxygen and exhales carbon dioxide. It is one of the important life activities, and it cannot stop at a moment. It is also a necessary process for gas exchange between the human body and the external environment. The normal person's breathing rhythm is uniform and the depth is appropriate.

(1) Normal breathing value When breathing calmly, adults 12 to 20 beats / min, children 30 to 40 beats / min, children's breathing decreased with age, gradually to adult levels. The ratio of the number of breaths to the number of pulses is 1:4.

(2) Respiratory counting method The counting of breathing can observe the number of fluctuations of the chest and abdomen of the patient, one breath for one breath, or the number of blows by the cotton wool at the nostrils, and how many times the number of bucks is 1 minute The number of breaths per minute.

(C) Two ways of breathing There are two ways for people to breathe normally, namely chest breathing and abdominal breathing. Breathing with thoracic undulating motion is chest breathing, which is more common in normal women and young people, and can also be seen in peritonitis patients and some patients with acute abdomen. Abdominal exercise-based breathing is abdominal breathing, which is more common in normal males and Children can also be seen in patients with pleurisy.

(four) changes in respiratory rate

1. Increased breathing (>20 beats / min): normal people are seen in emotional, exercise, eating, and increased temperature. Abnormalities are seen in high fever, pneumonia, asthma, heart failure, anemia, etc.

2. Respiratory slowdown (<12 beats / min): seen in increased intracranial pressure, intracranial tumors, anesthesia, excessive use of sedatives, pleurisy.

(5) Changes in respiratory depth

Deep and large breathing is severe metabolic acidosis, diabetic ketotoxicity, acidosis during uremia; respiratory is seen in excessive use of drugs, emphysema, electrolyte imbalance and so on.

(6) Changes in respiratory rhythm

1. Tide breathing: seen in patients with severe cerebral hypoxia, ischemia, severe heart disease, and late uremia.

2. Nod-like breathing: seen in a state of sudden death.

3. Stop breathing: seen in encephalitis, meningitis, increased intracranial pressure, dry pleurisy, pleural malignancy, rib fracture, severe pain.

4. Sigh-like breathing: seen in patients with neurosis, mental stress and depression.

Fourth, blood pressure

(A) the production of blood pressure to promote blood flow in the blood vessels and acts on the blood vessel wall called blood pressure, generally refers to arterial blood pressure. When the ventricle contracts, the most pressure in the artery is called systolic blood pressure; when the ventricle is dilated, the lowest pressure in the artery is called diastolic blood pressure. The difference between systolic and diastolic blood pressure is pulse pressure.

(B) normal blood pressure normal adult systolic blood pressure is 12 ~ 18.7kPa (90 ~ 140mmH), diastolic blood pressure 8 ~ 12kPa (60 ~ 90mmHg). Neonatal systolic blood pressure is 6.7 ~ 8.0kPa (50 ~ 60mmHg), diastolic blood pressure 4 ~ 5.3kPa (30 ~ 40mmHg. After 40 years old, systolic blood pressure can increase with age. Systolic pressure below 39 years old <18.7kPa ( 140 mmHg), 40 to 49 years old <20 kPa (150 mmHg), 50 to 59 years old <21 kPa (160 mmHg), 60 years old or older <22.6 kPa (170 mmHg).

(3) The blood pressure measurement method generally uses the upper arm radial artery as the measurement position, the patient takes the sitting position, exposes and straightens the elbow, the palm of the hand is up, opens the sphygmomanometer, lays flat, and makes the position of the patient's heart and the measured artery and sphygmomanometer The zero point of the mercury column is on the same horizontal line. Discharge the gas in the cuff and tie the cuff to the upper arm to prevent over-tightening or looseness, so that one or two fingers can be inserted, and the end of the cuff is inserted, a stethoscope is worn, and the artery is touched in the elbow After the beat, place the head of the stethoscope on it and hold it down with a little pressure. Open the mercury tank switch, hold the ball in your hand, and close the valve to inhale. Generally, raise the mercury column to 21~24kPa (160~180mmHg). Then slightly open the valve and slowly release the gas from the cuff. When the first weak sound is heard, the scale on the mercury column is the systolic pressure. Continue to deflate, when the sound suddenly weakens or disappears, the scale on the mercury column is diastolic pressure. If not heard, put the gas in the cuff and let the mercury column drop to zero. Stop for a while and then measure again.

(four) abnormal blood pressure

1. Hypertension: refers to the increase in systolic and diastolic blood pressure. Adult systolic blood pressure 140mmHg and diastolic blood pressure 90mmHg, called hypertension. If hypertension occurs, but other organs are asymptomatic, it is a primary hypertension; such as renal vascular disease, nephritis, adrenal cortical tumor, increased intracranial pressure, diabetes, atherosclerotic heart disease, hyperlipemia Hypertension caused by symptoms, hypernatremia, drinking, smoking, etc., is a secondary hypertension.

Definition and classification of blood pressure levels in adults over 18 years old

Systolic blood pressure (mm Hg) diastolic blood pressure (mm Hg);

Normal blood pressure < 120 and < 80;

Pre-hypertension 120-139 or 80-89;

Hypertension: 140 90;

Grade 1 hypertension 140-159 or 90-99;

Grade 2 hypertension 160 or 100;

Grade 3 hypertension 180 or 110;

Simple systolic hypertension 140 < 90.

2. Hypotension: refers to systolic blood pressure 18.6 kPa (90 mmHg), diastolic too 8 kPa (60 mmHg), more common in shock, myocardial infarction, cardiac insufficiency, adrenal insufficiency, severe dehydration, heart failure, hyponatremia Wait.

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