Mark Holland

This chapter reviews the symptoms, signs, and other vital information that can and should be obtained at the bedside of the sick; this information should be recorded, vetted for accuracy, and if it changes responded to promptly and appropriately. Some vital information, such as age, sex, and body weight, are stable, whereas others are dynamic and include the traditional vital signs, breathlessness, other subjective patient feelings, changes in breathing, weakness, mobility, and mental status; changes in these are associated with higher in-hospital mortality, higher resource use, longer length of stay, and higher long-term mortality.
The five vital signs of respiratory rate, temperature, pulse rate, blood pressure, and oxygen saturation are indicators of hypoperfusion and hypoxemia, which are the final common pathways of clinical deterioration and death. Little else is known about the changes and trends of individual vital signs during the entire course of acute illness in hospital. Therefore, the best judge as to whether a vital sign value is appropriate for a clinical situation is how patients feel and their mental and physical functions. It is unclear if routinely measuring vital signs is effective at promptly detecting adverse events, and to date, there are no high-quality, large, well-controlled studies of continuous vital monitoring that show that it is of benefit. Although patients with three or more seriously abnormal vital signs will require prompt intervention to restore circulatory and respiratory stability, for less sick patients, the situation is unclear. It is possible that simply observing these patients, asking them how they “feel”, and “worrying about them” may detect life-threatening illness earlier than frequent routine vital sign measurements.