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Vital signs
Vital signs
	An anesthetic machine with integrated systems for monitoring of several vital parameters, including blood pressure and heart rate
Purpose	assess the general physical health of a person

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Vital signs (also known as vitals) are a group of the four to six most crucial medical signs that indicate the status of the body's vital (life-sustaining) functions. These measurements are taken to help assess the general physical health of a person, give clues to possible diseases, and show progress toward recovery.^[1]^[2] The normal ranges for a person's vital signs vary with age, weight, sex, and overall health.^[3]

There are four primary vital signs: body temperature, blood pressure, pulse (heart rate), and breathing rate (respiratory rate), often notated as BT, BP, HR, and RR. However, depending on the clinical setting, the vital signs may include other measurements called the "fifth vital sign" or "sixth vital sign."

Early warning scores have been proposed that combine the individual values of vital signs into a single score. This was done in recognition that deteriorating vital signs often precede cardiac arrest and/or admission to the intensive care unit. Used appropriately, a rapid response team can assess and treat a deteriorating patient and prevent adverse outcomes.^[4]^[5]^[6]

Primary vital signs[edit]

There are four primary vital signs which are standard in most medical settings:^[7]

The equipment needed is a thermometer, a sphygmomanometer, and a watch.^[8] Although a pulse can be taken by hand, a stethoscope may be required for a clinician to take a patient's apical pulse.^[9]

Temperature[edit]

Temperature recording gives an indication of core body temperature, which is normally tightly controlled (thermoregulation), as it affects the rate of chemical reactions. Body temperature is maintained through a balance of the heat produced by the body and the heat lost from the body.^[10]

Temperature can be recorded in order to establish a baseline for the individual's normal body temperature for the site and measuring conditions.

Temperature can be measured from the mouth, rectum, axilla (armpit), ear, or skin. Oral, rectal, and axillary temperature can be measured with either a glass or electronic thermometer.^[11] Note that rectal temperature measures approximately 0.5 °C higher than oral temperature, and axillary temperature approximately 0.5 °C less than oral temperature.^[12] Aural and skin temperature measurements require special devices designed to measure temperature from these locations.^[11]

While 37 °C (98.6 °F) is considered "normal" body temperature, there is some variance between individuals. Most have a normal body temperature set point that falls within the range of 36.0 °C to 37.5 °C (96.5–99.5 °F).^[13]

The main reason for checking body temperature is to solicit any signs of systemic infection or inflammation in the presence of a fever. Fever is considered temperature of 37.8 °C (100.0 °F) or above.^[13] Other causes of elevated temperature include hyperthermia, which results from unregulated heat generation or abnormalities in the body's heat exchange mechanisms.^[13]

Temperature depression (hypothermia) also needs to be evaluated. Hypothermia is classified as temperature below 35 °C (95 °F).^[12]

It is also recommended to review the trend of the patient's temperature over time. A fever of 38 °C does not necessarily indicate an ominous sign if the patient's previous temperature has been higher.

Pulse[edit]

The pulse is the rate at which the heart beats while pumping blood through the arteries, recorded as beats per minute (bpm).^[11] It may also be called "heart rate". In addition to providing the heart rate, the pulse should also be evaluated for strength and obvious rhythm abnormalities.^[11] The pulse is commonly taken at the wrist (radial artery). Alternative sites include the elbow (brachial artery), the neck (carotid artery), behind the knee (popliteal artery), or in the foot (dorsalis pedis or posterior tibial arteries).^[11] The pulse is taken with the index finger and middle finger by pushing with firm yet gentle pressure at the locations described above, and counting the beats felt per 60 seconds (or per 30 seconds and multiplying by two).^[11] The pulse rate can also be measured by listening directly to the heartbeat using a stethoscope. The pulse may vary due to exercise, fitness level, disease, emotions, and medications.^[11] The pulse also varies with age. A newborn can have a heart rate of 100–⁠160 bpm, an infant (0–⁠5 months old) a heart rate of 90–⁠150 bpm, and a toddler (6–⁠12 months old) a heart rate of 80–140 bpm.^[12] A child aged 1–⁠3 years old can have a heart rate of 80–⁠130 bpm, a child aged 3–⁠5 years old a heart rate of 80–⁠120 bpm, an older child (age of 6–10) a heart rate of 70–⁠110 bpm, and an adolescent (age 11–⁠14) a heart rate of 60–105 bpm.^[12] An adult (age 15+) can have a heart rate of 60–100 bpm.^[12]

Respiratory rate[edit]

Average respiratory rates vary between ages, but the normal reference range for people age 18 to 65 is 16–20 breaths per minute.^[4] The value of respiratory rate as an indicator of potential respiratory dysfunction has been investigated but findings suggest it is of limited value. Respiratory rate is a clear indicator of acidotic states, as the main function of respiration is removal of CO₂ leaving bicarbonate base in circulation.

Blood pressure[edit]

Manual sphygmomanometer and stethoscope used to take blood pressure in clinic.

Blood pressure is recorded as two readings: a higher systolic pressure, which occurs during the maximal contraction of the heart, and the lower diastolic or resting pressure.^[11] In adults, a normal blood pressure is 120/80, with 120 being the systolic and 80 being the diastolic reading.^[12] Usually, the blood pressure is read from the left arm unless there is some damage to the arm. The difference between the systolic and diastolic pressure is called the pulse pressure. The measurement of these pressures is now usually done with an aneroid or electronic sphygmomanometer. The classic measurement device is a mercury sphygmomanometer, using a column of mercury measured off in millimeters. In the United States and UK, the common form is millimeters of mercury, while elsewhere SI units of pressure are used. There is no natural 'normal' value for blood pressure, but rather a range of values that on increasing are associated with increased risks. The guideline acceptable reading also takes into account other co-factors for disease. Therefore, elevated blood pressure (hypertension) is variously defined when the systolic number is persistently over 140–160 mmHg. Low blood pressure is hypotension. Blood pressures are also taken at other portions of the extremities. These pressures are called segmental blood pressures and are used to evaluate blockage or arterial occlusion in a limb (see Ankle brachial pressure index).

Other signs[edit]

In the U.S., in addition to the above four, many providers are required or encouraged by government technology-in-medicine laws to record the patient's height, weight, and body mass index.^[14] In contrast to the traditional vital signs, these measurements are not useful for assessing acute changes in state because of the rate at which they change; however, they are useful for assessing the impact of prolonged illness or chronic health problems.

The definition of vital signs may also vary with the setting of the assessment. Emergency medical technicians (EMTs), in particular, are taught to measure the vital signs of respiration, pulse, skin, pupils, and blood pressure as "the 5 vital signs" in a non-hospital setting.^[15]

Fifth vital signs[edit]

The "fifth vital sign" may refer to a few different parameters.

Pain is considered a standard fifth vital sign in some organizations, such as the U.S. Veterans Affairs.^[16] Pain is measured on a 0–⁠10 pain scale based on subjective patient reporting and may be unreliable.^[17] Some studies show that recording pain routinely may not change management.^[18]^[19]^[20]
Menstrual cycle^[21]^[22]
Oxygen saturation (as measured by pulse oximetry)^[23]^[24]^[25]
Blood glucose level^[26]

Sixth vital signs[edit]

There is no standard "sixth vital sign"; its use is more informal and discipline-dependent.

End-tidal CO₂^[27]^[28]
Functional status^[29]
Shortness of breath^[30]
Gait speed^[31]
Delirium^[32]

Variations by age[edit]

Reference ranges for blood pressure
Stage	Approximate age	Systolic		Diastolic
Stage	Approximate age	Range	Typical example	Range	Typical example
Infants	1 to 12 months	75-100^[33]	85	50–70^[33]	60
Toddlers	1 to 4 years	80-110^[33]	95	50–80^[33]	65
Preschoolers	3 to 5 years	80-110^[33]	95	50–80^[33]	65
School age	6 to 13 years	85-120^[33]	100	55–80^[33]	65
Adolescents	13 to 18 years	95-140^[33]	115	60–90^[33]	75

Children and infants have respiratory and heart rates that are faster than those of adults as shown in the following table :

Age	Normal heart rate (beats per minute)		Normal respiratory rate (breaths per minute)
Age	Range^[34]	Typical example	Range^[35]	Typical example
Newborn	100–160^[36]	130	30–50	40
0–5 months	90–150	120	25–40	30
6–12 months	80–140	110	20–30	25
1–3 years	80–130	105	20–30	25
3–5 years	80–120	100	20–30	25
6–10 years	70–110	90	15–30	20
11–14 years	60–105	80	12–20	16
15–20 years	60–100	80	12–30^[37]	20

Monitoring[edit]

Monitoring of vital parameters most commonly includes at least blood pressure and heart rate, and preferably also pulse oximetry and respiratory rate. Multimodal monitors that simultaneously measure and display the relevant vital parameters are commonly integrated into the bedside monitors in intensive care units, and the anesthetic machines in operating rooms. These allow for continuous monitoring of a patient, with medical staff being continuously informed of the changes in the general condition of a patient.

While monitoring has traditionally been done by nurses and doctors, a number of companies are developing devices that can be used by consumers themselves. These include Cherish Health, Scanadu and Azoi.

References[edit]

^ "Vital Signs".
^ "Emergency Physicians Home". www.emergencyphysicians.org.
^ "Vital Signs Table - ProHealthSys". 3 July 2013.
^ ^a ^b National Early Warning Score Development and Implementation Group (NEWSDIG) (2012). National Early Warning Score (NEWS): standardising the assessment of acute-illness severity in the NHS. London: Royal College of Physicians. ISBN 978-1-86016-471-2.
^ National Institute for Health and Clinical Excellence. Clinical guideline 50: Acutely ill patients in hospital. London, 2007.
^ "Acute care toolkit 6: the medical patient at risk: recognition and care of the seriously ill or deteriorating medical patient" (PDF). Royal College of Physicians of London. May 2013.
^ "Vital Signs". Cleveland Clinic. Retrieved 10 Sep 2020.
^ "Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)". www.hopkinsmedicine.org. 2022-06-14. Retrieved 2023-11-06.
^ "Apical Pulse: What It Is and How to Take It". Cleveland Clinic. Retrieved 2023-11-06.
^ "Vital Signs: How to Check My Vitals at Home". Cleveland Clinic. Retrieved 2023-11-06.
^ ^a ^b ^c ^d ^e ^f ^g ^h "Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)". www.hopkinsmedicine.org. Retrieved 2019-08-30.
^ ^a ^b ^c ^d ^e ^f "Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate". 2019-07-23.
^ ^a ^b ^c LeBlond RF, Brown DD, Suneja M, Szot JF (2014-09-05). DeGowin's diagnostic examination (10th ed.). New York: McGraw-Hill Education. ISBN 9780071814478. OCLC 876336892.
^ "What should I include when I record vital signs of my patients for MU? - Providers & Professionals - HealthIT.gov". Archived from the original on 2018-03-25. Retrieved 2014-08-24.
^ Emergency Care, 11th edition, pp. 226–244.
^ "Pain as the 5Th Vital Sign Toolkit" (PDF).
^ Lorenz KA, Sherbourne CD, Shugarman LR, Rubenstein LV, Wen L, Cohen A, Goebel JR, Hagenmeier E, Simon B, Lanto A, Asch SM (1 May 2009). "How Reliable is Pain as the Fifth Vital Sign?". J Am Board Fam Med. 22 (3): 291–298. doi:10.3122/jabfm.2009.03.080162. PMID 19429735.
^ Wellbery C (15 October 2006). "Tips From Other Journals - American Family Physician". American Family Physician. 74 (8): 1417–1418.
^ Mularski RA, White-Chu F, Overbay D, Miller L, Asch SM, Ganzini L (2006). "Measuring pain as the 5th vital sign does not improve quality of pain management". J Gen Intern Med. 21 (6): 607–12. doi:10.1111/j.1525-1497.2006.00415.x. PMC 1924634. PMID 16808744.
^ "The Fifth Vital Sign: Implementation of the Neonatal Infant Pain Scale" (PDF). Archived from the original (PDF) on 2012-05-26. Retrieved 2023-12-24.
^ American College of Obstetricians and Gynecologists. (2015). "Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Committee Opinion No. 651". Obstet Gynecol. 126: 143–6.
^ "Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign". Pediatrics. 118 (5). American Academy of Pediatrics, Committee on Adolescence, American College of Obstetricians and Gynecologists, Committee on Adolescent Health Care. 2006.
^ Mower W, Myers G, Nicklin E, Kearin K, Baraff L, Sachs C (1998). "Pulse oximetry as a fifth vital sign in emergency geriatric assessment". Acad Emerg Med. 5 (9): 858–65. doi:10.1111/j.1553-2712.1998.tb02813.x. PMID 9754497.
^ Mower W, Sachs C, Nicklin E, Baraff L (1997). "Pulse oximetry as a fifth pediatric vital sign". Pediatrics. 99 (5): 681–6. CiteSeerX 10.1.1.575.2200. doi:10.1542/peds.99.5.681. PMID 9113944.
^ Neff T (1988). "Routine oximetry. A fifth vital sign?". Chest. 94 (2): 227. doi:10.1378/chest.94.2.227a. PMID 3396392.
^ "Mining Vital Signs from Wearable Healthcare Device via Nonlinear Machine Learning". University of Hull. Archived from the original on 2016-08-17. Retrieved 2016-05-14.
^ Vardi A, Levin I, Paret G, Barzilay, Z (2000). "The sixth vital sign: end-tidal CO₂ in pediatric trauma patients during transport". Harefuah. 139 (3–4): 85–7, 168. PMID 10979461.
^ Holcomb JB, Salinas J, McManus JM, Miller CC, Cooke WH, Convertino VA (2005). "Manual vital signs reliably predict need for life-saving interventions in trauma patients". J Trauma. 59 (4): 821–8, discussion 828–9. doi:10.1097/01.ta.0000188125.44129.7c. PMID 16374268.
^ Bierman A (2001). "Functional Status: The Sixth Vital Sign". J Gen Intern Med. 16 (11): 785–6. doi:10.1111/j.1525-1497.2001.10918.x. PMC 1495293. PMID 11722694.
^ "Nursing care of dyspnea: the 6th vital sign in individuals with chronic obstructive pulmonary disease (COPD)". National Guideline Clearinghouse. Archived from the original on 2009-01-17. Retrieved 2009-01-16.
^ Studenski S, Perera S, Wallace D, et al. (2003). "Physical performance measures in the clinical setting" (PDF). J Am Geriatr Soc. 51 (9): 314–322. doi:10.1046/j.1532-5415.2003.51104.x. PMID 12588574. S2CID 31083716.
^ Bellelli G, Trabucchi M (May 1, 2008). "Delirium as the Sixth Vital Sign". Journal of the American Medical Directors Association. 9 (4): 279, author reply 279–80. doi:10.1016/j.jamda.2007.08.014. PMID 18457806 – via www.jamda.com.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j PEDIATRIC AGE SPECIFIC Archived 2017-05-16 at the Wayback Machine, page 6. Revised 6/10. By Theresa Kirkpatrick and Kateri Tobias. UCLA Health System
^ Emergency Care, Page 214
^ Emergency Care, Page 215
^ Vorvick L. "Pulse". MedlinePlus. U.S. National Library of Medicine. Retrieved 23 January 2011.
^ "Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate". 2019-07-23.

[1] "Vital Signs".

[2] "Emergency Physicians Home". www.emergencyphysicians.org.

[3] "Vital Signs Table - ProHealthSys". 3 July 2013.

[RCP2012-4] National Early Warning Score Development and Implementation Group (NEWSDIG) (2012). National Early Warning Score (NEWS): standardising the assessment of acute-illness severity in the NHS. London: Royal College of Physicians. ISBN 978-1-86016-471-2.

[NICECG50-5] National Institute for Health and Clinical Excellence. Clinical guideline 50: Acutely ill patients in hospital. London, 2007.

[RCP-6] "Acute care toolkit 6: the medical patient at risk: recognition and care of the seriously ill or deteriorating medical patient" (PDF). Royal College of Physicians of London. May 2013.

[7] "Vital Signs". Cleveland Clinic. Retrieved 10 Sep 2020.

[8] "Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)". www.hopkinsmedicine.org. 2022-06-14. Retrieved 2023-11-06.

[9] "Apical Pulse: What It Is and How to Take It". Cleveland Clinic. Retrieved 2023-11-06.

[10] "Vital Signs: How to Check My Vitals at Home". Cleveland Clinic. Retrieved 2023-11-06.

[:0-11] ^ ^a ^b ^c ^d ^e ^f ^g ^h "Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)". www.hopkinsmedicine.org. Retrieved 2019-08-30.

[:1-12] ^ ^a ^b ^c ^d ^e ^f "Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate". 2019-07-23.

[:2-13] LeBlond RF, Brown DD, Suneja M, Szot JF (2014-09-05). DeGowin's diagnostic examination (10th ed.). New York: McGraw-Hill Education. ISBN 9780071814478. OCLC 876336892.

[14] "What should I include when I record vital signs of my patients for MU? - Providers & Professionals - HealthIT.gov". Archived from the original on 2018-03-25. Retrieved 2014-08-24.

[15] Emergency Care, 11th edition, pp. 226–244.

[16] "Pain as the 5Th Vital Sign Toolkit" (PDF).

[17] Lorenz KA, Sherbourne CD, Shugarman LR, Rubenstein LV, Wen L, Cohen A, Goebel JR, Hagenmeier E, Simon B, Lanto A, Asch SM (1 May 2009). "How Reliable is Pain as the Fifth Vital Sign?". J Am Board Fam Med. 22 (3): 291–298. doi:10.3122/jabfm.2009.03.080162. PMID 19429735.

[18] Wellbery C (15 October 2006). "Tips From Other Journals - American Family Physician". American Family Physician. 74 (8): 1417–1418.

[19] Mularski RA, White-Chu F, Overbay D, Miller L, Asch SM, Ganzini L (2006). "Measuring pain as the 5th vital sign does not improve quality of pain management". J Gen Intern Med. 21 (6): 607–12. doi:10.1111/j.1525-1497.2006.00415.x. PMC 1924634. PMID 16808744.

[20] "The Fifth Vital Sign: Implementation of the Neonatal Infant Pain Scale" (PDF). Archived from the original (PDF) on 2012-05-26. Retrieved 2023-12-24.

[21] American College of Obstetricians and Gynecologists. (2015). "Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Committee Opinion No. 651". Obstet Gynecol. 126: 143–6.

[22] "Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign". Pediatrics. 118 (5). American Academy of Pediatrics, Committee on Adolescence, American College of Obstetricians and Gynecologists, Committee on Adolescent Health Care. 2006.

[23] Mower W, Myers G, Nicklin E, Kearin K, Baraff L, Sachs C (1998). "Pulse oximetry as a fifth vital sign in emergency geriatric assessment". Acad Emerg Med. 5 (9): 858–65. doi:10.1111/j.1553-2712.1998.tb02813.x. PMID 9754497.

[24] Mower W, Sachs C, Nicklin E, Baraff L (1997). "Pulse oximetry as a fifth pediatric vital sign". Pediatrics. 99 (5): 681–6. CiteSeerX 10.1.1.575.2200. doi:10.1542/peds.99.5.681. PMID 9113944.

[25] Neff T (1988). "Routine oximetry. A fifth vital sign?". Chest. 94 (2): 227. doi:10.1378/chest.94.2.227a. PMID 3396392.

[26] "Mining Vital Signs from Wearable Healthcare Device via Nonlinear Machine Learning". University of Hull. Archived from the original on 2016-08-17. Retrieved 2016-05-14.

[27] Vardi A, Levin I, Paret G, Barzilay, Z (2000). "The sixth vital sign: end-tidal CO₂ in pediatric trauma patients during transport". Harefuah. 139 (3–4): 85–7, 168. PMID 10979461.

[ncbi.nlm.nih.gov-28] Holcomb JB, Salinas J, McManus JM, Miller CC, Cooke WH, Convertino VA (2005). "Manual vital signs reliably predict need for life-saving interventions in trauma patients". J Trauma. 59 (4): 821–8, discussion 828–9. doi:10.1097/01.ta.0000188125.44129.7c. PMID 16374268.

[29] Bierman A (2001). "Functional Status: The Sixth Vital Sign". J Gen Intern Med. 16 (11): 785–6. doi:10.1111/j.1525-1497.2001.10918.x. PMC 1495293. PMID 11722694.

[30] "Nursing care of dyspnea: the 6th vital sign in individuals with chronic obstructive pulmonary disease (COPD)". National Guideline Clearinghouse. Archived from the original on 2009-01-17. Retrieved 2009-01-16.

[31] Studenski S, Perera S, Wallace D, et al. (2003). "Physical performance measures in the clinical setting" (PDF). J Am Geriatr Soc. 51 (9): 314–322. doi:10.1046/j.1532-5415.2003.51104.x. PMID 12588574. S2CID 31083716.

[32] Bellelli G, Trabucchi M (May 1, 2008). "Delirium as the Sixth Vital Sign". Journal of the American Medical Directors Association. 9 (4): 279, author reply 279–80. doi:10.1016/j.jamda.2007.08.014. PMID 18457806 – via www.jamda.com.

[ucla-33] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j PEDIATRIC AGE SPECIFIC Archived 2017-05-16 at the Wayback Machine, page 6. Revised 6/10. By Theresa Kirkpatrick and Kateri Tobias. UCLA Health System

[34] Emergency Care, Page 214

[35] Emergency Care, Page 215

[36] Vorvick L. "Pulse". MedlinePlus. U.S. National Library of Medicine. Retrieved 23 January 2011.

[37] "Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate". 2019-07-23.

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@@ Line 1: / Line 1: @@
+{{short description|Group of the 4-6 important medical signs that indicate the status of the body's vital functions}}
+{{cs1 config|name-list-style=vanc}}
 {{other uses}}
 {{Infobox diagnostic
@@ Line 20: / Line 22: @@
 | LOINC           = <!--{{LOINC|code}}-->
 }}
-'''Vital signs''' (also known as '''vitals''') are a group of the four to six most important [[medical signs]] that indicate the status of the body’s [[wikt:vital#Adjective|vital]] (life-sustaining) functions. These measurements are taken to help assess the general physical health of a person, give clues to possible diseases, and show progress toward recovery.<ref>{{cite web|url=http://my.clevelandclinic.org/healthy_living/prevention/hic_vital_signs.aspx|title=Vital Signs|publisher=}}</ref><ref>http://www.emergencycareforyou.org/VitalCareMagazine/ER101/Default.aspx?id=500</ref> The normal ranges for a person’s vital signs vary with age, weight, gender, and overall [[health]].<ref>{{cite web|url=http://prohealthsys.com/site/resources/assessment/physical-assessment/vital-signs/vital_signs_table/|title=Vital Signs Table - ProHealthSys|publisher=}}</ref>
+'''Vital signs''' (also known as '''vitals''') are a group of the four to six most crucial [[medical signs]] that indicate the status of the body's [[wikt:vital#Adjective|vital]] (life-sustaining) functions. These measurements are taken to help assess the general physical health of a person, give clues to possible diseases, and show progress toward recovery.<ref>{{cite web|url=http://my.clevelandclinic.org/healthy_living/prevention/hic_vital_signs.aspx|title=Vital Signs}}</ref><ref>{{cite web|url=http://www.emergencyphysicians.org/|title=Emergency Physicians Home|website=www.emergencyphysicians.org}}</ref> The normal ranges for a person's vital signs vary with age, weight, [[sex]], and overall [[health]].<ref>{{cite web|url=http://prohealthsys.com/site/resources/assessment/physical-assessment/vital-signs/vital_signs_table/|title=Vital Signs Table - ProHealthSys|date=3 July 2013 }}</ref>
-There are four '''primary vital signs''': [[body temperature]], [[blood pressure]], [[pulse]] ([[heart rate]]), and breathing rate ([[respiratory rate]]), often notated as BT, BP, HR, and RR. However, depending on the clinical setting, the vital signs may include other measurements called the "fifth vital sign" or "sixth vital sign". Vital signs are recorded using the [[LOINC]] internationally accepted standard coding system.<ref>{{cite web|url=https://loinc.org/|title=Logical Observation Identifiers Names and Codes}}</ref><ref>{{cite web|url=https://loinc.org/news/loinc-a-lingua-franca-critical-for-electronic-medical-records-and-health-information-exchange.html/?searchterm=blood%20pressure|title=LOINC - A Lingua Franca Critical for Electronic Medical Records and Health Information Exchange}}</ref>
+There are four '''primary vital signs''': [[body temperature]], [[blood pressure]], [[pulse]] ([[heart rate]]), and breathing rate ([[respiratory rate]]), often notated as BT, BP, HR, and RR. However, depending on the clinical setting, the vital signs may include other measurements called the "fifth vital sign" or "sixth vital sign."
-[[Early warning score]]s have been proposed that combine the individual values of vital signs into a single score. This was done in recognition that deteriorating vital signs often precede [[cardiac arrest]] and/or admission to the [[intensive care unit]]. Used appropriately, a [[rapid response team]] can assess and treat a deteriorating patient and prevent adverse outcomes.<ref name=RCP2012>{{cite book|author=National Early Warning Score Development and Implementation Group (NEWSDIG) |title=National Early Warning Score (NEWS): standardising the assessment of acute-illness severity in the NHS|date=2012|publisher=Royal College of Physicians|location=London|isbn=978-1-86016-471-2}}</ref><ref name=NICECG50>{{NICE|50|Acutely ill patients in hospital|2007}}</ref><ref name=RCP>{{cite web | title=Acute care toolkit 6: the medical patient at risk: recognition and care of the seriously ill or deteriorating medical patient | date=May 2013 | url=https://www.rcplondon.ac.uk/sites/default/files/acute_care_toolkit_6.pdf | publisher=Royal College of Physicians of London}}</ref>
+[[Early warning score]]s have been proposed that combine the individual values of vital signs into a single score. This was done in recognition that deteriorating vital signs often precede [[cardiac arrest]] and/or admission to the [[intensive care unit]]. Used appropriately, a [[Rapid response team (medicine)|rapid response team]] can assess and treat a deteriorating patient and prevent adverse outcomes.<ref name=RCP2012>{{cite book|author=National Early Warning Score Development and Implementation Group (NEWSDIG) |title=National Early Warning Score (NEWS): standardising the assessment of acute-illness severity in the NHS|date=2012|publisher=Royal College of Physicians|location=London|isbn=978-1-86016-471-2}}</ref><ref name=NICECG50>{{NICE|50|Acutely ill patients in hospital|2007}}</ref><ref name=RCP>{{cite web | title=Acute care toolkit 6: the medical patient at risk: recognition and care of the seriously ill or deteriorating medical patient | date=May 2013 | url=https://www.rcplondon.ac.uk/sites/default/files/acute_care_toolkit_6.pdf | publisher=Royal College of Physicians of London}}</ref>
 == Primary vital signs ==
-There are four primary vital signs which are standard in most medical settings:
+There are four primary vital signs which are standard in most medical settings:<ref>{{cite web | title = Vital Signs | publisher = Cleveland Clinic | url = https://my.clevelandclinic.org/health/articles/10881-vital-signs | access-date = 10 Sep 2020}}</ref>
 # [[Human body temperature|Body temperature]]
@@ Line 34: / Line 36: @@
 # [[Blood pressure]]
-The equipment needed is a [[thermometer]], a [[sphygmomanometer]], and a [[watch]]. Although a pulse can be taken by hand, a [[stethoscope]] may be required for a patient with a very weak pulse.
+The equipment needed is a [[thermometer]], a [[sphygmomanometer]], and a [[watch]].<ref>{{cite web |date=2022-06-14 |title=Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure) |url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/vital-signs-body-temperature-pulse-rate-respiration-rate-blood-pressure |access-date=2023-11-06 |website=www.hopkinsmedicine.org |language=en}}</ref> Although a pulse can be taken by hand, a [[stethoscope]] may be required for a clinician to take a patient's apical pulse.<ref>{{cite web |title=Apical Pulse: What It Is and How to Take It |url=https://my.clevelandclinic.org/health/articles/23346-apical-pulse |access-date=2023-11-06 |website=Cleveland Clinic |language=en}}</ref>
 ===Temperature===
-[[Temperature examination|Temperature recording]] gives an indication of [[core temperature|core body temperature]] which is normally tightly controlled ([[thermoregulation]]) as it affects the rate of chemical reactions. Body temperature is maintained through a balance of the heat produced by the body and the heat lost from the body.
+[[Temperature examination|Temperature recording]] gives an indication of [[core temperature|core body temperature]], which is normally tightly controlled ([[thermoregulation]]), as it affects the rate of chemical reactions. Body temperature is maintained through a balance of the heat produced by the body and the heat lost from the body.<ref>{{cite web |title=Vital Signs: How to Check My Vitals at Home |url=https://my.clevelandclinic.org/health/articles/10881-vital-signs |access-date=2023-11-06 |website=Cleveland Clinic |language=en}}</ref>
-[[File:Thermometer (Oral Glass).png|thumb|Oral glass thermometer]]
+[[File:Thermometer (Oral Glass).png|thumb|Oral glass thermometer showing a body temperature in °F]]
 Temperature can be recorded in order to establish a baseline for the individual's normal body temperature for the site and measuring conditions.
-Temperature can be measured from the mouth, rectum, axilla (armpit), ear, or skin. Oral, rectal, and axillary temperature can be measured with either a glass or electronic thermometer.<ref name=":0" /> Note that rectal temperature measures approximately 1°F greater than oral temperature, and axillary temperature measures about 1°F less than oral temperature.<ref name=":1" /> Aural and skin temperature measurements require special devices designed to measure temperature from these locations. <ref name=":0" />
+Temperature can be measured from the mouth, rectum, axilla (armpit), ear, or skin. Oral, rectal, and axillary temperature can be measured with either a glass or electronic thermometer.<ref name=":0" /> Note that rectal temperature measures approximately 0.5&nbsp;°C higher than oral temperature, and axillary temperature approximately 0.5&nbsp;°C less than oral temperature.<ref name=":1" /> Aural and skin temperature measurements require special devices designed to measure temperature from these locations.<ref name=":0" />
-While 98.6 °F/ 37°C is considered "normal" body temperature, there is some variance between individuals. Most have a normal body temperature set point that falls within the range of 36.0°C to 37.5°C (96.5–99.5°F).<ref name=":2">{{Cite book|title=DeGowin's diagnostic examination|last=LeBlond|first=Richard F.|last2=Brown|first2=Donald D.|last3=Suneja|first3=Manish|last4=Szot|first4=Joseph F.|isbn=9780071814478|edition=10th|location=New York|publisher=[[McGraw-Hill Education]]|oclc=876336892|date=2014-09-05}}</ref>
+While 37&nbsp;°C (98.6&nbsp;°F) is considered "normal" body temperature, there is some variance between individuals. Most have a normal body temperature set point that falls within the range of 36.0&nbsp;°C to 37.5&nbsp;°C (96.5–99.5&nbsp;°F).<ref name=":2">{{cite book|title=DeGowin's diagnostic examination|last1=LeBlond|first1=Richard F.|last2=Brown|first2=Donald D.|last3=Suneja|first3=Manish|last4=Szot|first4=Joseph F.|isbn=9780071814478|edition=10th|location=New York|publisher=[[McGraw-Hill Education]]|oclc=876336892|date=2014-09-05}}</ref>
-The main reason for checking body temperature is to solicit any signs of systemic infection or inflammation in the presence of a [[fever]]. Fever is considered oral temperature of >99.5°F or rectal temperature of  >100.5°F<ref name=":2" />. Other causes of elevated temperature include [[hyperthermia]], which results from unregulated heat generation or abnormalities in the body's heat exchange mechanisms.<ref name=":2" />
+The main reason for checking body temperature is to solicit any signs of systemic infection or inflammation in the presence of a [[fever]]. Fever is considered temperature of 37.8&nbsp;°C (100.0&nbsp;°F) or above.<ref name=":2" /> Other causes of elevated temperature include [[hyperthermia]], which results from unregulated heat generation or abnormalities in the body's heat exchange mechanisms.<ref name=":2" />
-Temperature depression ([[hypothermia]]) also needs to be evaluated. Hypothermia is classified as temperature below 35 °C/95 °F . <ref name=":1" />
+Temperature depression ([[hypothermia]]) also needs to be evaluated. Hypothermia is classified as temperature below 35&nbsp;°C (95&nbsp;°F).<ref name=":1" />
 It is also recommended to review the trend of the patient's temperature over time. A fever of 38&nbsp;°C does not necessarily indicate an ominous sign if the patient's previous temperature has been higher.
-<br />
 ===Pulse===
 {{Main|Pulse}}
 [[File:Pulse (Wrist).png|thumb|An individual taking their own radial pulse.]]
-The pulse is the rate at which the heart beats while pumping blood through the arteries, recorded as beats per minute (bpm).<ref name=":0">{{Cite web|url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/vital-signs-body-temperature-pulse-rate-respiration-rate-blood-pressure|title=Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)|website=www.hopkinsmedicine.org|language=en|access-date=2019-08-30}}</ref> It may also be called "heart rate". In addition to providing the heart rate, the pulse should also be evaluated for strength and obvious rhythm abnormalities.<ref name=":0" /> The pulse is commonly taken at the wrist ([[radial artery]]). Alternative sites include the elbow ([[brachial artery]]), the neck ([[carotid artery]]), behind the knee ([[popliteal artery]]), or in the foot ([[Dorsalis pedis artery|dorsalis pedis]] or [[Posterior tibial artery|posterior tibial]] arteries).<ref name=":0" /> The pulse is taken with the index finger and middle finger by pushing with firm yet gentle pressure at the locations described above, and counting the beats felt per 60 seconds (or per 30 seconds and multiplying by two).<ref name=":0" /> The pulse rate can also be measured by listening directly to the [[Cardiac cycle|heartbeat]] using a [[stethoscope]].  The pulse may vary due to exercise, fitness level, disease, emotions, and medications. <ref name=":0" /> The pulse also varies with age. A [[newborn]] can have a heart rate of 100-160 bpm, an [[infant]] (0-5 months old) a heart rate of 90–150 bpm, and a [[toddler]] (6-12 months old) a heart rate of 80–140 bpm.<ref name=":1">{{Cite journal|date=2019-07-23|title=Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate|url=https://emedicine.medscape.com/article/2172054-overview#a2}}</ref> A child aged 1-3 years old can have a heart rate of 80-130 bpm, a child aged 3-5 years old a heart rate of 80-120 bpm, an older child (age of 6-10) a heart rate of 70-110 bpm, and an [[adolescent]] (age 11-14) a heart rate of 60–105 bpm.<ref name=":1" /> An adult (age 15+) can have a heart rate of 60–100 bpm.<ref>{{Cite journal|date=2019-07-23|title=Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate|url=https://emedicine.medscape.com/article/2172054-overview#a2}} {{verify source |date=September 2019 |reason=This ref was deleted Special:Diff/913122415 by a bug in VisualEditor and later restored by a bot from the original cite located at Special:Permalink/910940781 cite #9 - verify the cite is accurate and delete this template. [[User:GreenC_bot/Job_18]]}}</ref>
+The pulse is the rate at which the heart beats while pumping blood through the arteries, recorded as beats per minute (bpm).<ref name=":0">{{cite web|url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/vital-signs-body-temperature-pulse-rate-respiration-rate-blood-pressure|title=Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)|website=www.hopkinsmedicine.org|language=en|access-date=2019-08-30}}</ref> It may also be called "heart rate". In addition to providing the heart rate, the pulse should also be evaluated for strength and obvious rhythm abnormalities.<ref name=":0" /> The pulse is commonly taken at the wrist ([[radial artery]]). Alternative sites include the elbow ([[brachial artery]]), the neck ([[carotid artery]]), behind the knee ([[popliteal artery]]), or in the foot ([[Dorsalis pedis artery|dorsalis pedis]] or [[Posterior tibial artery|posterior tibial]] arteries).<ref name=":0" /> The pulse is taken with the index finger and middle finger by pushing with firm yet gentle pressure at the locations described above, and counting the beats felt per 60 seconds (or per 30 seconds and multiplying by two).<ref name=":0" /> The pulse rate can also be measured by listening directly to the [[Cardiac cycle|heartbeat]] using a [[stethoscope]]. The pulse may vary due to exercise, fitness level, disease, emotions, and medications.<ref name=":0" /> The pulse also varies with age. A [[newborn]] can have a heart rate of 100–⁠160 bpm, an [[infant]] (0–⁠5 months old) a heart rate of 90–⁠150 bpm, and a [[toddler]] (6–⁠12 months old) a heart rate of 80–140 bpm.<ref name=":1">{{cite web|date=2019-07-23|title=Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate| url=https://emedicine.medscape.com/article/2172054-overview#a2}}</ref> A child aged 1–⁠3 years old can have a heart rate of 80–⁠130 bpm, a child aged 3–⁠5 years old a heart rate of 80–⁠120 bpm, an older child (age of 6–10) a heart rate of 70–⁠110 bpm, and an [[adolescent]] (age 11–⁠14) a heart rate of 60–105 bpm.<ref name=":1" /> An adult (age 15+) can have a heart rate of 60–100 bpm.<ref name=":1"/>
 ===Respiratory rate===
@@ Line 70: / Line 70: @@
 == Other signs ==
-In the U.S., in addition to the above four, many providers are required or encouraged by government technology-in-medicine laws to record the patient's height, weight, and [[body mass index]].<ref>{{cite web|url=http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/record-vital-signs|title=What should I include when I record vital signs of my patients for MU? - Providers & Professionals - HealthIT.gov|publisher=}}</ref> In contrast to the traditional vital signs, these measurements are not useful for assessing acute changes in state because of the rate at which they change; however, they are useful for assessing the impact of prolonged illness or chronic health problems.
+In the U.S., in addition to the above four, many providers are required or encouraged by government technology-in-medicine laws to record the patient's height, weight, and [[body mass index]].<ref>{{cite web|url=http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/record-vital-signs|title=What should I include when I record vital signs of my patients for MU? - Providers & Professionals - HealthIT.gov|access-date=2014-08-24|archive-date=2018-03-25|archive-url=https://web.archive.org/web/20180325142200/https://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/record-vital-signs|url-status=dead}}</ref> In contrast to the traditional vital signs, these measurements are not useful for assessing acute changes in state because of the rate at which they change; however, they are useful for assessing the impact of prolonged illness or chronic health problems.
 The definition of vital signs may also vary with the setting of the assessment. [[Emergency medical technicians]] (EMTs), in particular, are taught to measure the vital signs of respiration, pulse, skin, [[Pupil diameter|pupils]], and blood pressure as "the 5 vital signs" in a non-hospital setting.<ref>Emergency Care, 11th edition, pp. 226–244.</ref>
@@ Line 77: / Line 77: @@
 The "fifth vital sign" may refer to a few different parameters.
-* [[Pain]] is considered a standard fifth vital sign in some organizations, such as the U.S. [[United States Department of Veterans Affairs|Veterans Affairs]].<ref>http://www.va.gov/painmanagement/docs/toolkit.pdf</ref> Pain is measured on a 0-10 [[pain scale]] based on subjective patient reporting and may be unreliable.<ref>{{cite journal|title=How Reliable is Pain as the Fifth Vital Sign?|first1=Karl A.|last1=Lorenz|first2=Cathy D.|last2=Sherbourne|first3=Lisa R.|last3=Shugarman|first4=Lisa V.|last4=Rubenstein|first5=Li|last5=Wen|first6=Angela|last6=Cohen|first7=Joy R.|last7=Goebel|first8=Emily|last8=Hagenmeier|first9=Barbara|last9=Simon|first10=Andy|last10=Lanto|first11=Steven M.|last11=Asch|date=1 May 2009|journal=J Am Board Fam Med|volume=22|issue=3|pages=291–298|doi=10.3122/jabfm.2009.03.080162|pmid=19429735|doi-access=free}}</ref> Some studies show that recording pain routinely may not change management.<ref>{{cite web|url=http://www.aafp.org/afp/2006/1015/p1417a.html|title=Tips From Other Journals - American Family Physician|publisher=}}</ref><ref>{{cite journal | pmc = 1924634 | pmid=16808744 | doi=10.1111/j.1525-1497.2006.00415.x | volume=21 | issue=6 | title=Measuring pain as the 5th vital sign does not improve quality of pain management | year=2006 | journal=J Gen Intern Med | pages=607–12 |vauthors=Mularski RA, White-Chu F, Overbay D, Miller L, Asch SM, Ganzini L }}</ref><ref>http://www.pain-initiative-un.org/doc-center/en/docs/The%20Fifth%20Vital%20Sign%20Implementation.pdf</ref>
+* [[Pain]] is considered a standard fifth vital sign in some organizations, such as the U.S. [[United States Department of Veterans Affairs|Veterans Affairs]].<ref>{{cite web| url=http://www.va.gov/painmanagement/docs/toolkit.pdf | title=Pain as the 5Th Vital Sign Toolkit}}</ref> Pain is measured on a 0–⁠10 [[pain scale]] based on subjective patient reporting and may be unreliable.<ref>{{cite journal|title=How Reliable is Pain as the Fifth Vital Sign?|first1=Karl A.|last1=Lorenz|first2=Cathy D.|last2=Sherbourne|first3=Lisa R.|last3=Shugarman|first4=Lisa V.|last4=Rubenstein|first5=Li|last5=Wen|first6=Angela|last6=Cohen|first7=Joy R.|last7=Goebel|first8=Emily|last8=Hagenmeier|first9=Barbara|last9=Simon|first10=Andy|last10=Lanto|first11=Steven M.|last11=Asch|date=1 May 2009|journal=J Am Board Fam Med|volume=22|issue=3|pages=291–298|doi=10.3122/jabfm.2009.03.080162|pmid=19429735|doi-access=free}}</ref> Some studies show that recording pain routinely may not change management.<ref>{{cite journal|url=http://www.aafp.org/afp/2006/1015/p1417a.html|title=Tips From Other Journals - American Family Physician|journal=American Family Physician |date=15 October 2006 |volume=74 |issue=8 |pages=1417–1418 |last1=Wellbery |first1=Caroline }}</ref><ref>{{cite journal | pmc = 1924634 | pmid=16808744 | doi=10.1111/j.1525-1497.2006.00415.x | volume=21 | issue=6 | title=Measuring pain as the 5th vital sign does not improve quality of pain management | year=2006 | journal=J Gen Intern Med | pages=607–12 |vauthors=Mularski RA, White-Chu F, Overbay D, Miller L, Asch SM, Ganzini L }}</ref><ref>{{cite web| url=http://www.pain-initiative-un.org/doc-center/en/docs/The%20Fifth%20Vital%20Sign%20Implementation.pdf | access-date=2023-12-24 | title=The Fifth Vital Sign: Implementation of the Neonatal Infant Pain Scale | archive-url=https://web.archive.org/web/20120526120744/http://www.pain-initiative-un.org/doc-center/en/docs/The%20Fifth%20Vital%20Sign%20Implementation.pdf| archive-date=2012-05-26}}</ref>
-* [[Menstrual cycle]] <ref>{{cite journal |author=American College of Obstetricians and Gynecologists. |title=Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Committee Opinion No. 651 |journal=Obstet Gynecol |volume=126 |pages=143–6 |year=2015 }}</ref><ref>{{cite journal |author=American Academy of Pediatrics, Committee on Adolescence, American College of Obstetricians and Gynecologists, Committee on Adolescent Health Care. |title=Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign |journal=Pediatrics |volume=118 |issue=5 |year=2006 }}</ref>
+* [[Menstrual cycle]]<ref>{{cite journal |author=American College of Obstetricians and Gynecologists. |title=Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Committee Opinion No. 651 |journal=Obstet Gynecol |volume=126 |pages=143–6 |year=2015 }}</ref><ref>{{cite journal |publisher=American Academy of Pediatrics, Committee on Adolescence, American College of Obstetricians and Gynecologists, Committee on Adolescent Health Care. |title=Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign |journal=Pediatrics |volume=118 |issue=5 |year=2006 }}</ref>
-* [[Oxygen saturation (medicine)|Oxygen saturation]]  (as measured by [[pulse oximetry]])<ref>{{cite journal |vauthors=Mower W, Myers G, Nicklin E, Kearin K, Baraff L, Sachs C |title=Pulse oximetry as a fifth vital sign in emergency geriatric assessment |journal=Acad Emerg Med |volume=5 |issue=9 |pages=858–65 |year=1998 |pmid=9754497 |doi=10.1111/j.1553-2712.1998.tb02813.x}}</ref><ref>{{cite journal |vauthors=Mower W, Sachs C, Nicklin E, Baraff L |title=Pulse oximetry as a fifth pediatric vital sign |journal=Pediatrics |volume=99 |issue=5 |pages=681–6 |year=1997 |pmid=9113944 |doi=10.1542/peds.99.5.681|citeseerx=10.1.1.575.2200 }}</ref><ref>{{cite journal |author=Neff T |title=Routine oximetry. A fifth vital sign? |journal=Chest |volume=94 |issue=2 |pages=227 |year=1988 |pmid=3396392 |doi=10.1378/chest.94.2.227a}}</ref>
+* [[Oxygen saturation (medicine)|Oxygen saturation]] (as measured by [[pulse oximetry]])<ref>{{cite journal |author1=Mower W|author2=Myers G| author3= Nicklin E| author4=Kearin K|author5=Baraff L|author6=Sachs C |title=Pulse oximetry as a fifth vital sign in emergency geriatric assessment |journal=Acad Emerg Med |volume=5 |issue=9 |pages=858–65 |year=1998 |pmid=9754497 |doi=10.1111/j.1553-2712.1998.tb02813.x|doi-access=free }}</ref><ref>{{cite journal |author1=Mower W|author2=Sachs C|author3=Nicklin E|author4=Baraff L |title=Pulse oximetry as a fifth pediatric vital sign |journal=Pediatrics |volume=99 |issue=5 |pages=681–6 |year=1997 |pmid=9113944 |doi=10.1542/peds.99.5.681|citeseerx=10.1.1.575.2200 }}</ref><ref>{{cite journal |author=Neff T |title=Routine oximetry. A fifth vital sign? |journal=Chest |volume=94 |issue=2 |pages=227 |year=1988 |pmid=3396392 |doi=10.1378/chest.94.2.227a|doi-access=free }}</ref>
-* Blood [[Glucose]] level <ref>{{cite web|url=http://www2.hull.ac.uk/pgmi2/phd-scholarships-2016/mining-vital-signs.aspx|title=Mining Vital Signs from Wearable Healthcare Device via Nonlinear Machine Learning|publisher=University of Hull|access-date=2016-05-14}}</ref>
+* [[Blood glucose]] level<ref>{{cite web|url=http://www2.hull.ac.uk/pgmi2/phd-scholarships-2016/mining-vital-signs.aspx|title=Mining Vital Signs from Wearable Healthcare Device via Nonlinear Machine Learning|publisher=University of Hull|access-date=2016-05-14|archive-date=2016-08-17|archive-url=https://web.archive.org/web/20160817005338/http://www2.hull.ac.uk/pgmi2/phd-scholarships-2016/mining-vital-signs.aspx|url-status=dead}}</ref>
 === Sixth vital signs ===
 There is no standard "sixth vital sign"; its use is more informal and discipline-dependent.
-* End-tidal [[CO2|{{CO2}}]].<ref>{{cite journal |vauthors=Vardi A, Levin I, Paret G, Barzilay Z |title=The sixth vital sign: end-tidal CO<sub>2</sub> in pediatric trauma patients during transport |journal=Harefuah |volume=139 |issue=3–4 |pages=85–7, 168 |year=2000 |pmid=10979461}}</ref><ref name="ncbi.nlm.nih.gov">{{cite journal |pmid=16374268 | volume=59 | issue=4 | title=Manual vital signs reliably predict need for life-saving interventions in trauma patients | year=2005 | journal=J Trauma | pages=821–8; discussion 828–9 |vauthors=Holcomb JB, Salinas J, McManus JM, Miller CC, Cooke WH, Convertino VA | doi=10.1097/01.ta.0000188125.44129.7c}}</ref>
+* End-tidal [[CO2|{{CO2}}]]<ref>{{cite journal |author1=Vardi A|author2=Levin I|author3=Paret G|author4=Barzilay, Z |title=The sixth vital sign: end-tidal CO<sub>2</sub> in pediatric trauma patients during transport |journal=Harefuah |volume=139 |issue=3–4 |pages=85–7, 168 |year=2000 |pmid=10979461}}</ref><ref name="ncbi.nlm.nih.gov">{{cite journal |pmid=16374268 | volume=59 | issue=4 | title=Manual vital signs reliably predict need for life-saving interventions in trauma patients | year=2005 | journal=J Trauma | pages=821–8; discussion 828–9 |vauthors=Holcomb JB, Salinas J, McManus JM, Miller CC, Cooke WH, Convertino VA | doi=10.1097/01.ta.0000188125.44129.7c}}</ref>
-* [[Functional status]]<ref>{{cite journal |author=Bierman A |title=Functional Status: The Sixth Vital Sign |journal=J Gen Intern Med |volume=16 |issue=11 |pages=785–6 |year=2001 |pmc=1495293 |pmid=11722694 |doi=10.1111/j.1525-1497.2001.10918.x}}</ref>
+* Functional status<ref>{{cite journal |author=Bierman A |title=Functional Status: The Sixth Vital Sign |journal=J Gen Intern Med |volume=16 |issue=11 |pages=785–6 |year=2001 |pmc=1495293 |pmid=11722694 |doi=10.1111/j.1525-1497.2001.10918.x}}</ref>
 * [[Shortness of breath]]<ref>{{cite web |url=http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=7008&nbr=4217#s21 |title=Nursing care of dyspnea: the 6th vital sign in individuals with chronic obstructive pulmonary disease (COPD). |publisher=National Guideline Clearinghouse |access-date=2009-01-16 |archive-url=https://web.archive.org/web/20090117040751/http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=7008&nbr=4217#s21 |archive-date=2009-01-17 |url-status=dead }}</ref>
-* Gait speed<ref>{{cite journal  |vauthors=Studenski S, Perera S, Wallace D, etal |title=Physical performance measures in the clinical setting |journal=J Am Geriatr Soc |volume= 51 |issue=9 |pages=314–322 |year=2003 |doi=10.1046/j.1532-5415.2003.51104.x |pmid=12588574|url=http://www.jhsph.edu/research/centers-and-institutes/roger-c-lipitz-center-for-integrated-health-care/Pra_PraPlus/studenski_et_al.pdf }}</ref>
+* Gait speed<ref>{{cite journal  |vauthors=Studenski S, Perera S, Wallace D, etal |title=Physical performance measures in the clinical setting |journal=J Am Geriatr Soc |volume= 51 |issue=9 |pages=314–322 |year=2003 |doi=10.1046/j.1532-5415.2003.51104.x |pmid=12588574|s2cid=31083716 |url=http://www.jhsph.edu/research/centers-and-institutes/roger-c-lipitz-center-for-integrated-health-care/Pra_PraPlus/studenski_et_al.pdf }}</ref>
+* Delirium<ref>{{cite journal|url=https://www.jamda.com/article/S1525-8610(08)00072-8/abstract|title=Delirium as the Sixth Vital Sign|first1=Giuseppe|last1=Bellelli|first2=Marco|last2=Trabucchi|date=May 1, 2008|journal=Journal of the American Medical Directors Association|volume=9|issue=4|pages=279; author reply 279–80|via=www.jamda.com|doi=10.1016/j.jamda.2007.08.014|pmid=18457806}}</ref>
-* Delirium <ref>https://www.jamda.com/article/S1525-8610(08)00072-8/fulltext</ref>
 == Variations by age ==
@@ Line 97: / Line 97: @@
 !rowspan=2| Stage !!rowspan=2| Approximate age !!colspan=2| Systolic !!colspan=2| Diastolic
 |-
-| Range || Typical example || Range || Typical example
+! Range || Typical example || Range || Typical example
 |-
 ! Infants
-| 1 to 12 months || 75-100<ref name=ucla>[http://hr.uclahealth.org/workfiles/AgeSpecificSLM-Peds.pdf PEDIATRIC AGE SPECIFIC], page 6. Revised 6/10. By Theresa Kirkpatrick and Kateri Tobias. UCLA Health System</ref> || 85 || 50–70<ref name=ucla/> || 60
+| 1 to 12 months || 75-100<ref name=ucla>[http://hr.uclahealth.org/workfiles/AgeSpecificSLM-Peds.pdf PEDIATRIC AGE SPECIFIC] {{Webarchive|url=https://web.archive.org/web/20170516204947/http://hr.uclahealth.org/workfiles/AgeSpecificSLM-Peds.pdf |date=2017-05-16 }}, page 6. Revised 6/10. By Theresa Kirkpatrick and Kateri Tobias. UCLA Health System</ref> || 85 || 50–70<ref name=ucla/> || 60
 |-
 ! Toddlers
@@ Line 114: / Line 114: @@
 | 13 to 18 years || 95-140<ref name=ucla/> || 115 || 60–90<ref name=ucla/> || 75
 |}
-Children and infants have respiratory and heart rates that are faster than those of adults as shown in the following table:
+Children and infants have respiratory and heart rates that are faster than those of adults as shown in the following table :
 {|class="wikitable" style="text-align:center"
 !rowspan=2| Age
-!colspan=2|Normal heart rate<br>(beats per minute)
+!colspan=2|Normal heart rate<br />(beats per minute)
-!colspan=2|Normal respiratory rate<br>(breaths per minute)
+!colspan=2|Normal respiratory rate<br />(breaths per minute)
 |-
-| Range<ref>''Emergency Care'', Page 214</ref> || Typical example || Range<ref>''Emergency Care'', Page 215</ref> || Typical example
+! Range<ref>''Emergency Care'', Page 214</ref> || Typical example || Range<ref>''Emergency Care'', Page 215</ref> || Typical example
 |-
+!Newborn
-|Newborn || 100–160<ref>{{cite web|last=Vorvick|first=Linda|title=Pulse|url=https://www.nlm.nih.gov/medlineplus/ency/article/003399.htm|work=MedlinePlus|publisher=U.S. National Library of Medicine|accessdate=23 January 2011}}</ref>  || 130 || 30–50 || 40
+| 100–160<ref>{{cite web|last=Vorvick|first=Linda|title=Pulse|url=https://www.nlm.nih.gov/medlineplus/ency/article/003399.htm|work=MedlinePlus|publisher=U.S. National Library of Medicine|access-date=23 January 2011}}</ref>  || 130 || 30–50 || 40
 |-
-|0–5 months || 90–150 || 120 || 25–40 || 30
+!0–5 months
+| 90–150 || 120 || 25–40 || 30
 |-
-|6–12 months || 80–140 || 110 || 20–30 || 25
+!6–12 months
+| 80–140 || 110 || 20–30 || 25
 |-
-|1–3 years || 80–130 || 105 || 20–30 || 25
+!1–3 years
+| 80–130 || 105 || 20–30 || 25
 |-
-|3–5 years || 80–120 || 100 || 20–30 || 25
+!3–5 years
+| 80–120 || 100 || 20–30 || 25
 |-
-|6–10 years || 70–110 || 90 || 15–30 || 20
+!6–10 years
+| 70–110 || 90 || 15–30 || 20
 |-
-|11–14 years || 60–105 || 80 || 12–20 || 16
+!11–14 years
+| 60–105 || 80 || 12–20 || 16
 |-
+!15–20 years
-|15–20 years || 60–100 || 80 || 12–30<ref>{{Cite journal|date=2019-07-23|title=Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate|url=https://emedicine.medscape.com/article/2172054-overview#a3}}</ref>|| 20
+| 60–100 || 80 || 12–30<ref>{{cite web|date=2019-07-23|title=Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate|url=https://emedicine.medscape.com/article/2172054-overview#a3}}</ref>|| 20
 |}
 ==Monitoring==
-[[monitoring (medicine)|Monitoring]] of vital parameters most commonly includes at least [[blood pressure]] and [[heart rate]], and preferably also [[pulse oximetry]] and [[respiratory rate]]. Multimodal monitors that simultaneously measure and display the relevant vital parameters are commonly integrated into the bedside monitors in [[intensive care unit]]s, and the [[anesthetic machine]]s in [[operating room]]s. These allow for continuous monitoring of a patient, with medical staff being continuously informed of the changes in general condition of a patient.
+[[monitoring (medicine)|Monitoring]] of vital parameters most commonly includes at least [[blood pressure]] and [[heart rate]], and preferably also [[pulse oximetry]] and [[respiratory rate]]. Multimodal monitors that simultaneously measure and display the relevant vital parameters are commonly integrated into the bedside monitors in [[intensive care unit]]s, and the [[anesthetic machine]]s in [[operating room]]s. These allow for continuous monitoring of a patient, with medical staff being continuously informed of the changes in the general condition of a patient.
-While monitoring has traditionally been done by nurses and doctors, a number of companies are developing devices which can be used by consumers themselves. These include [http://www.cherishhealth.com Cherish Health], [[Scanadu]] and [[Azoi]].
+While monitoring has traditionally been done by nurses and doctors, a number of companies are developing devices that can be used by consumers themselves. These include Cherish Health, [[Scanadu]] and Azoi.
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