Why get vitals
Reflects body basic fucntions
Detects abnormal functioning
What is the 5th vital
Pain
Scale 1-10
What type of sound is the Bell of the stethoscope used for?
Low frequency sound (with light pressure)
What types of sound is the Diaphragm of the stethoscope used for?
High pitched sounds (i.e. 300hz)
What is a normal heart rate?
60-100 bpm (140 in infants)
What is tachycardia?
> 100 bpm
What is bradycardia?
< 60 bpm
What does an EKG measure?
Rhythm
What is a regular pulse rhythm?
Normal
What is a regular irregularity pulse?
Repetitive irregular pattern
Seen in premature atrial or ventricular contraction
What is an irregular irregularity pulse?
Random irregular pattern
Seen in atrial dysthytmia (i.e. atrial fibrillation)
Explain pulsus differens
Volume differences between two different pulses
Seen in local stenosis or compression of the paths of the vessel with the weaker pulse
What is the scale for amplitude of pulse?
4 - bounding 3 - full and increased 2 - normal 1 - diminished, barely palpable, thready 0 - absent, not palpable
What can cause a pulse amplitude of 4?
Aortic regurgitation
What can cause a pulse amplitude of 3?
Hyperdynamic circulation (hyperthyroidism)
What can cause a pulse amplitude of 1?
Heart failure
What can cause a pulse amplitude of 0?
Obstruction or shock
Describe a Pulsus alterans. What can cause it?
Alternating weak and strong beat with ah normal rhythm.
Usually associated with a left-sided S3.
Seen in left ventricular failure
Describe a Pulsus Bisferiens. What can cause it?
Biphasic pulse
Has 2 main peaks
2 strong systolic beats separated by a mid systolic dip
Seen in aortic regurgitation with or w/o stenosis
Describe a Pulsus Bigeminal. What can cause it?
2 beats in rapid succession
Normal beat plus premature beat
The two beast vary in amplitude due to the reduced stroke volume of the second beat
Seen in premature ventricular contraction
Describe a Pulsus Paradoxus. What can cause it?
Exaggeration of the normal fall in amplitude of the pulse during inspiration
Decreased is determined by changes in the systolic blood pressure
Normal - 10mmHg fall during inspiration
If a fall is greater than 12-15mmHg, indicative of Pulsus Paradoxus
Seen in severe obstructive lung disease, pericadial tamponande, constrictive pericarditis
Describe a Water Hammer Pulse. What can cause it?
AKA Corrigan pulse, Collapsing pulse
Greater amplitude, rapid rise/upstroke, normal summit, sudden descent
Due to a blackflow through the aortic valve
Seen in aortic regurgitation and patent ductus arteriosus
Describe a large, bounding pulse. What can cause it?
Defined as 3+
Does not fade out with pressure - not easily obliterated
Seen in hyperdynamic circulation (i.e. hyperthyroidism)
What is a pulse deficit? What can cause it?
Difference between the heart rate by auscultation at the apex and the peripheral pulse rate by palpation
Seen in atrial fibrillation, rapid irregular rhythms
What is a radio-femoral delay? What can cause it to be abnormal?
Normal transmission of a pulse wave is 75ms (radial artery) and 70ms (femoral artery)
Longer when there is obstruction to the flow of blood
Seen in Leriche’s syndrome (isolated aortic-iliac disease), post-subclavian coarctation of the aorta
What is Quinke’s sign? What does it indicate?
Capillary pulsation in the nail bed
Manifests as alternating flushing and blanching of the nail bed due to pulsations in the subpapillary arteriolar and venous plexuses
Seen in aortic insufficiency
What is Durozie’s sign? What does it indicate?
Femoral bruit (“pistol shot”)
Normally a bruit is only heard in systole.
Durozie’s is seen in both systole and diastole (two phase bruit), heard over the peripheral arteries (i.e. femoral).
Rapid “back and forth” flow of blood - as seen in aortic insufficiency
What is de Mussett’s sign? What does it indicate?
Head nodding coinciding with the carotid pulse
Seen in aortic regurgitation
What does a positive Osler maneuver mean?
Rigid wall is indicative of atherosclerotic disease of the blood vessel
What are the factors that can affect blood pressure?
Force of the heart's pumping action Amount of resistance in the blood vessels Amount of blood in the blood vessels Pain, emotion Age, disease, obesity Drugs/medication Physical fitness Trauma
What does the cardiac center effect?
Influences heart rate and myocardial contractility
What does the vasomotor center effect?
Influences systemic vascular resistance
What do the baroreceptors monitor?
Arterial blood pressure
What do the chemoreceptors monitor?
CO2 and O2
What is the hormonal regulation of blood pressure?
Renin-Angiotensin-Aldosterone syndrome
What is the cardiac output? What is it dependent on?
Amount of blood moved with each heart beat Dependent on: - Blood volume - Water/sodium intake - water/sodium loss
What factors can influence SV?
- Preload (volume of fluid flowing into the right atrium)
- Afterload (pressure generated by the LV that will be required to pump blood into the aorta)
- Intropy (degree of ventricular contractility)
Under normal circumstances, what controls the heart rate?
Sponatneous rhythmic disrachge of the sino-atrial node 100-110 beats/minute Can be modified by the ANS - Vagus nerve (PSNS - decreases HR) - SNS - stimulates
What is the maximum achievable heart rate?
220 - age in years = # bpm
What is the BP if you can paplate a radial pulse? Femoral pulse? Carotid pulse?
Radial - 80mmHg
Femoral - 70mmHg
Carotid - 60mmHg
What are the accessory muscles of respiration?
Intercostals, SCM, levator scapulae, scalene muscles, erector spinae
What are the accessory muscles of expiration?
Abdominals and intercostals
What happens, anatomically, during inspiration?
Diaphragm contracts, lowers its dome (flattens), descends and there is an increase in the vertical diameter of the thoracic cavity
Elevation of the ribs increases the transverse and antero-posterior diameter of the chest
This decreases the intrathoracic pressure - drawing air in
What happens, anatomically, during expiration?
There is elastic recoil of the lung
The relaxed diaphragm moves upward
Decreases the vertical diameter of the chest
Increases the intrathroacic pressure - pushing air out
Where are the neurogenic respiratory centers located? What influences them?
Pons and medulla
Limbic system
What does the Medullary Rhythmicity center regulate?
Quite respiratory rhythm (baseline) set and controlled
What does the Apneustic center regulate?
Controls the depth of inspiration, allowing response to an increased demand for O2
What does the Pneumotaxic center regulate?
Controls the rate of inspiration by controlling the duration of inspiration
Explain the Hering-Breuer reflex
Based on peripheral stretch receptors located in teh smooth muscle of the bronchi and bonchioles
They act during labored breathing triggered by increased demand for O2 (exercising, mountain climbing)
Protective reflexes, mediated by the Vagus nerve, that prevents over inflation (expansion) of the lungs by terminating inspiration
What are the central chemoreceptors? How do they impact respiration?
Located in the interstitial space outside of the BBB
They respond to PCO and pH within the CSF
When pH drops - respiration increases
What are the peripheral chemoreceptors? How do they impact respiration?
They are located in the carotid and aortic bodies
They are responsive to PPO2 in the arterial blood - triggered when O2 drops less than 60mmHg
Afferent of carotid body is the glossopharyngeal nerve; Aortic body - Vagus nerve
What is the hemodynamic effect of respiration?
Inspiration increases (prolongs) right heart and shortens (decreases) left heart activities Expiration increases (prolongs) left heart and shortens (decreases) right heart activities
What can cause abnormal respiration?
Emotions (i.e. anxiety, fear) Pain Exercise Smoking Environment (i.e. temperature, altitude) Medication (narcotics depress respiration, stimulating increase respiration) Medical conditions
What is a normal rate for breathing?
14-20bpm (up to 44 for children)
What is bradypnea? What can cause it?
<10bpm
Seen in CNS diseases, metabolic disorders, raised intracranial pressure
What is tachypnea? What can cause it?
> 24bpm - rapid shallow
Seen in restrictive lung disease, pleuritic chest pain, elevated diaphragm due to increased intra-abdominal pressure
What is hyperpnea? What can cause it?
> 24bpm - rapid deep
Seen in exercise, anxiety, metabolic acidosis, midbrain/pontine abnormalities (infection, hypoxia, hypoglycemia)
What is Biot’s breathing? What can cause it?
Ataxic breathing - unpredictable irregularity
May be shallow, deep or cease for a short period
Seen in respiratory depression and midbrain damage at the medulla
What is Cheyne-stokes breathing? What can cause it?
Deep alternating with periods of apnea
Seen in brain damage (both sides of cerebral hemisphere), heart failure, uremia, drug induced respiratory depression
What is prolonged expiration? What can cause it?
Takes a long time to breath out
Seen in obstructive lung disease (i.e. asthma, COPD)
What qualifies as a fever?
Over 99oF in adults
Over 101oF in infants less than 3 months old
Seen in infection, trauma, drug reaction, hyperdynamic state
What qualifies as hypothermia?
Core body temperature of under 95oF
Seen in exposure to cold, hypothyroidism
What are factors affecting temperature?
Gender Recent activity Food and fluid consumption Time of day Stage of menstrual cycle
What is hyperpyrexia? What can cause it?
Temperature over 106oF
Seen in septicemia
What is a continuous fever?
During a 24hr period, the temperature is persistently above normal
What is an intermittent fever?
Diurnal variation - the temperature fluctuates between normal and elevation during a 24hr period (i.e. Malaria)
What is a remittent fever?
Abating and relapsing in cycles (but always stays above normal)
What is a relapsing (recurrent) fever?
Recurrent, acute episodes of fever and defervescence of varying duration.
There is spontaneous abatement and then recurrence of varying duration.
Febrile episodes typically last 5-7 days.
What symptoms are seen when a temperature is rising?
Feeling cold and shivering
What symptoms are seen when a temperature is falling?
Hot and sweating
