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11/13/24, 7\:28 PM Guide | Vital signs

Vital signs

Table of contents
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Background

Measuring and recording observations and calculating a National Early Warning Score 2 (NEWS2) can appear in OSCEs. You’ll
be expected to correctly record clinical observations (also known as vital signs), record the
score.
NEWS2 is a track-and-trigger system to identify adult patients at risk of clinical deterioration. The score is comprised of six
components\:
1
Respiratory rate (RR)
Oxygen saturation (SpO )
2
Temperature
Systolic blood pressure (BP)
Heart rate (HR)
Level of consciousness
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An overview of the NEWS2 scoring system [2]

Gather equipment

Pulse oximeter
Blood pressure monitor
Thermometer
Watch
NEWS2 chart

Introduction

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Brie
Gain consent to proceed with recording observations (vital signs).
Ask if the patient has any pain before proceeding.
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Wash your hands

Heart rate (HR)

Assessing heart rate

1. Palpate the patient’s radial pulse, located at the radial side of the wrist, with the tips of your index and middle

2. Once you have located the radial pulse, assess the rate and rhythm.
You can calculate the heart rate in several ways, including measuring for 60 seconds, measuring for 30 seconds and
multiplying by 2 or measuring for 15 seconds and multiplying by 4. The shorter the interval used, the higher the risk of obtaining
an inaccurate result, so wherever possible, you should palpate for a full 60 seconds.
For irregular rhythms, you should measure the pulse for a full 60 seconds to improve accuracy.
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Assess pulse rate
Normal and abnormal heart rates
In healthy adults, the pulse should be between 60 - 100 bpm. An irregular rhythm is most commonly caused by atrial

A pulse \<60 bpm is known as bradycardia and has a wide range of aetiologies (e.g. healthy athletic individuals,
atrioventricular block, medications, sick sinus syndrome).
A pulse of >100 bpm is known as tachycardia and also has a wide range of aetiologies (e.g. anxiety, supraventricular
tachycardia, hypovolaemia, hyperthyroidism).

Respiratory rate (RR)

Assessing respiratory rate

1. Whilst still palpating the radial pulse (but no longer counting it), assess the patient’s respiratory rate. Palpation of the radial
pulse at this stage is purely to avoid making the patient aware you are directly observing their breathing, as this can alter the
respiratory rate.
2. Note any asymmetries in the expiratory and inspiratory phases of respiration (e.g. the expiratory phase is often prolonged in
asthma exacerbations and in patients with COPD).
3. Assess the patient’s respiratory rate for 60 seconds.
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Assessing the respiratory rate
Respiratory rate abnormalities
In healthy adults, the respiratory rate should be between 12-20 breaths per minute.
A respiratory rate of fewer than 12 breaths per minute is referred to as bradypnoea (e.g. opiate overdose).
A respiratory rate of more than 20 breaths per minute is referred to as tachypnoea (e.g. acute asthma).

Oxygen saturation (SpO2)

Oxygen saturation is measured using a pulse oximeter. When recording oxygen saturations, note whether the patient is on
supplemental oxygen or breathing room air.
1. Select an appropriate site for the pulse oximeter. If using the
2. Switch on the pulse oximeter.
3. Place the pulse oximeter over the
4. Wait for the oxygen saturation level to appear and note the reading.
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Assess SpO2
Target oxygen saturation
NEWS2 has two di
Scale 1 has a target oxygen saturation of ≥ 96% and is used for most patients.
Scale 2 has a target oxygen saturation of 88 - 92% and is used for patients at risk of hypercapnic respiratory failure (e.g.
patients with COPD).

Blood pressure (BP)

Measurement of blood pressure can be performed manually using a stethoscope and sphygmomanometer or by using an
automatic blood pressure monitor.
The NEWS2 score only assigns a score based on the systolic blood pressure. However, the diastolic blood pressure should be
recorded on the chart.

Attach the blood pressure cu

1. Ensure the cu
2. Wrap the cu
3. Line up the cu

Estimate an approximate systolic blood pressure

1. Palpate the radial pulse.
2. In
3. Note the reading on the sphygmomanometer. This is a rough estimate of the systolic blood pressure.

Measure the blood pressure accurately

1. Place your stethoscope’s diaphragm over the brachial artery.
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2. Re-in
3. Begin to slowly de
4. Listen carefully, you will begin to hear a thumping pulsatile noise known as the 1st Korotoko
this 1st sound is heard is the systolic blood pressure.
5. Continue to de
sound is referred to as the 5th Korotko
If the patient is noted to be hypertensive (>140/90) or hypotensive you should re-check the blood pressure after 2 minutes to
con
See our full guide to measuring blood pressure with a video demonstration for more details.
Assess blood pressure

Level of consciousness

A patient's level of consciousness can be measured using the ACVPU scale\:
Alert\: the patient is fully alert with spontaneous eye-opening
Confusion (new)\: the patient is alert, but confused or disorientated
Voice\: the patient responds to a verbal stimulus
Pain\: the patient responds to a pain stimulus only
Unresponsive\: no response to voice or pain stimulus

Temperature

Temperature is usually assessed using a tympanic thermometer as this is a rapid and non-invasive way of recording
temperature.
Other methods for recording temperature include oral, rectal and axillary readings.

Measure temperature using a tympanic thermometer

The exact method of use will depend on the brand of the tympanic thermometer. Always follow the manufacturer’s
instructions and local guidelines.
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1. Ensure the tympanic thermometer is switched on, clean and in good working order.
2. Place a disposable cover over the probe end.
3. Place the probe into the ear canal and gently advance until the probe seals the opening of the ear canal.
4. Record the tympanic temperature.
5. Remove and dispose of the tympanic thermometer cover.
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