Vital Signs and Escalation

A vital sign is a measurement; a vital-sign pattern is clinical evidence. Temperature, heart rate, respiratory rate, blood pressure, SpO2, and level of consciousness show how the patient is responding to infection, impaired oxygenation, altered perfusion, pain, medication effects, or metabolic stress. The direction of change often matters more than one isolated value. The body may compensate before it fails. Heart rate can rise to preserve cardiac output when stroke volume or circulating volume falls. Respirations may become rapid with hypoxemia, metabolic acidosis, pain, or anxiety. Blood pressure can remain acceptable during early compensation and then fall abruptly. A new change in level of consciousness may reflect hypoxemia, hypercapnia, cerebral hypoperfusion, or a medication effect. SpO2 estimates hemoglobin saturation but does not measure ventilation, so an apparently acceptable saturation does not rule out dangerous hypoventilation. For stable adults, the minimum vital-sign set is obtained at least every 12 hours. If any parameter is outside institutional normal limits, the frequency increases to at least every 30 minutes, or more often when the patient's condition requires it. These intervals are a floor,...