Vital signs (which generally are taken after primary, secondary, and head-to-toe surveys have been completed) include taking the patient's pulse, respiration, blood pressure, and temperature. Depending on local protocols, the patient's level of consciousness as well as eye pupil size and reactivity may be recorded with vital signs. Skin characteristics, such as temperature, color, and moistness or dryness, can also be conveniently determined at this time.

Pulse.-When taking a patient's pulse, you should be concerned with two factors: rate and character. For pulse rate, you will have to determine the number of beats per minute. Pulse rate is classified as normal, rapid, or slow. A normal pulse rate for adults is between 60 to 80 beats per minute. Any pulse rate above 100 beats per minute is rapid (tachycardia), while a rate below 60 beats per minute is slow yes"> (bradycardia).

NOTE: An athlete may have a normal at-rest pulse rate between 40 and 50 beats per minute. This is a slow pulse rate, but is not an indication of poor health.

Pulse character is the rhythm and force of the pulse. Pulse rhythm is evaluated as regular or irregular. When intervals between beats are constant, the pulse is regular, and when intervals are not constant, the pulse is described as irregular. Pulse force refers to the pressure of the pulse wave as it expands the artery. Pulse force is determined as full or thready. A full pulse feels as if a strong wave has passed under your fingertips. When the pulse feels weak and thin, the pulse is described as thready.

The pulse rate and character can be determined at a number of points throughout the body. The most common site to determine a patient's pulse is the radial pulse. The radial pulse (wrist pulse) is named after the radial artery found in the lateral aspect of the forearm.

Respiration.-Respiration is the act of breathing. Asingle breath is the complete process of breathing in (inhalation) followed by breathing out (exhalation). When observing respiration in connection to vital signs, you should be concerned with two factors: rate and character.

Respiration rate is the number of breaths a patient takes in 1 minute. The rate of respiration is classified as normal, rapid, or slow. The normal respiration rate for an adult at rest is 12 to 20 breaths per minute. A rapid respiration rate is more than 28 respirations per minute, and a slow respiration rate is less than 10 breaths per minute. A rapid or slow respiration rate indicates the patient is in need of immediate medical attention and should be transported to a medical treatment facility as soon as possible.

Respiration character includes rhythm, depth, ease of breathing, and sound. Respiration rhythm refers to the manner in which a person breathes. Respiration rhythm is classified as regular or irregular. Aregular rhythm is when the interval between breaths is constant, and an irregular rhythm is when the interval between breaths varies.

Respiration depth refers to the amount of air moved between each breath. Respiration depth is classified as normal, deep, or shallow.

Ease of breathing can be judged while you are judging depth. Ease of breathing may be judged as labored, difficult, or painful.

Sounds of respiration include snoring, wheezing, crowing (birdlike sounds), and gurgling (sounds like breaths are passing through water).

You should count respirations as soon as you have determined the pulse rate. Count the number of breaths taken by the patient during 30 seconds and multiply by 2 to obtain the breaths per minute. While you are counting breaths, note the rhythm, depth, ease of breathing, and sounds of respiration.

Blood Pressure.-The measurement of the pressure blood exerts against the wall of blood vessels is known as blood pressure. The pressure created in the arteries when the heart pumps blood out into circulation (heart beat) is called the systolic blood pressure. The pressure remaining in the arteries when the heart is relaxed (between beats) is called the diastolic blood pressure. The systolic pressure is always reported first and the diastolic pressure second (e.g., 120 over 80).

Blood pressure varies from one person to another and is measured with a stethoscope and a sphygmomanometer (BP cuff). Low blood pressure (hypotension) is considered to exist when the systolic pressure falls below 90 millimeters of mercury (mm Hg) and/or the diastolic falls below 60. "Millimeters of mercury" refers to the units of the BP cuff's gauge. High blood pressure (hypertension) exists once the pressure rises above 150/90 mmHg. Keep in mind that patients may exhibit a temporary rise in blood pressure during emergency situations. More than one reading will be necessary to determine if a high or low reading is only temporary. If a patient's blood pressure drops, the patient may be going into shock. You should report major changes in blood pressure immediately to medical facility personnel.

Temperature.-Body temperatures are determined by the measurement of oral, rectal, axillary (armpit), and aural (ear) temperatures. In emergency situations, taking a traditional body temperature may not be indicated, so a relative skin temperature may be done. A relative skin temperature is a quick assessment of skin temperature and condition. To assess skin temperature and condition, feel the patient's forehead with the back of your hand. In doing this, note if the patient's skin feels normal, warm, hot, cool, or cold. At the same time, see if the skin is dry, moist, or clammy. Also check for "goose pimples," indicating chills.