II. Precautions: Abnormal Vital Signs
- Unaddressed Abnormal Vital Signs (e.g. abnormal or unrepeated at discharge) are associated with serious adverse outcomes
- Likelihood of poor outcome correlates with the specific Vital Sign, number and severity of the abnormality
- Persistently abnormal vitals signs (esp. Tachycardia and Hypotension) are at the highest risk of adverse outcome
- Unaddressed Abnormal Vital Signs are commonly cited in Malpractice suits
- Approach to Abnormal Vital Signs to avoid preventable errors
- Review nursing notes and Vital Signs throughout the clinical encounter
- Repeat and review Vital Signs at discharge
- Explain Abnormal Vital Signs in the context of symptoms and chief complaint prior to discharge
- Also consider differential diagnosis
- Exercise caution when Vital Sign changes are out of proportion to what would be routinely expected
- Arrange close interval follow-up for patients considered safe for discharge
- Consider hospital admission or observation for persistent abnormalities, multiple comorbities, higher risk
- References
- Carlson and Long (2023) Abnormal Vital Signs in Adults at Discharge, EM:Rap, accessed 8/2/2023
- Gabayan (2017) Acad Emerg Med 24(7):846-54 +PMID: 28375565 [PubMed]
- Hoang (2021) CJEM 23(6): 767-71 +PMID: 34586622 [PubMed]
- Nguyen (2017) J Gen Intern Med 32(1):42-8 +PMID: 27503438 [PubMed]
- Sklar (2007) Ann Emerg Med 49(6): 735-45 +PMID:17210204 [PubMed]
III. Precautions: Specific Measures
- Automatic Blood Pressure cuffs may be unreliable
- Check manual Blood Pressure for outlying values (esp. shock, Narrow Pulse Pressure, Severe Hypertension)
- Oxygen Saturation may be unreliable (e.g. shock state, nail polish)
IV. Evaluation: Abnormal Criteria
- See Pediatric Vital Signs
- Adults (18 to 65 years old)
- Heart Rate >100
- Systolic Blood Pressure <90 mmHg
- Temperature >100.4 F (38 C)
- Older Adults (>65 years, proposed changes to Emergency Severity Index)
- Heart Rate >90
- Systolic Blood Pressure <110 mmHg
- Temperature >99.3 F (37.4 C)