Temperature, pulse, respiratory rate (TPR) + EWS

Question 1

Importance of pulse

Answer 1

• force of heart contraction
• rate of heart contraction
• clue to outflow problems
• circulating blood volume
• state of blood vessels

Question 2

Where can limb pulses be found?

Answer 2

Brachial artery (bend of elbow)
Radial artery (outer aspect of wrist)
Femoral artery (inner aspect of groin)

Question 3

What do you feel in a pulse examination?

Answer 3

examine with tips of 2nd, 3rd + 4th fingers
compare left + right
measured at rest for at least 30 seconds

• rate
• rhythm
• character
• auscultation (listening)

low = bradycardia
high = tachycardia

Question 4

What are normal heart rate ranges for different ages?

Answer 4

Newborn = 70-120 bpm
Infant = 80-160 bpm
Preschool child = 75-120 bpm
School child = 70-100 bpm
Adult = 60-90 bpm

Question 5

Describe pulse rhythm

Answer 5

• regular

- irregular (irregularly irregular/regularly irregular)

Question 6

Describe pulse character

Answer 6

Sharp rise - small plateau - normal fall

Question 7

Describe pulse auscultation

Answer 7

normal flow in arteries/veins = quiet
bruit = turbulent flow/produces noise
murmur = across a heart valve

Question 8

What is a normal respiratory rate?

Answer 8

12-20 per minute

Question 9

Increased respiratory rate causes

Answer 9

lung disease
heart disease
anxiety
metabolic problems

Question 10

Decreased respiratory rate causes

Answer 10

brain damage

drugs

Question 11

Features to look for when measuring respiratory rate

Answer 11

• depth/effort
• irregular/stop-start patterns
• coughing
• wheeze (expiration noise)
• stridor (inspiration noise)
• odour (alcohol/tobacco/ketones)

Question 12

What is the normal temperature range?

Answer 12

36-37.5 degrees celsius

Question 13

Hyperthermia/pyrexia causes

Answer 13

• infection
• drugs
• heat stroke
• stroke (affects basal ganglia)
• autonomic diseases
• malignancy
• gout

Question 14

Hypothermia causes

Answer 14

(below 35 degrees celsius)

• multifactorial
• alcohol
• drugs
• hypoglycaemia
• hypoadrenalism
• infections
• post-operative

Question 15

What is EWS?

Answer 15

Early Warning Score

• predicts critically unwell/deteriorating patients
• helps prioritisation of cases

Question 16

What is CVPU?

Answer 16

Measure of alertness/responsiveness
C = confusion
V = voice (louder voice to rouse)
P = pain
U = unresponsive/unconscious