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Vital sings ___________ lecture 1

1. Blood pressure :
devices used to measure blood pressure
1. Stethoscope
2 . sphygmomanometer and sphygmomanometer cuff
Stethoscope :
it is a device use to listen the internal sound such heart sound
and bowel sound and blood flow , it is used to measure blood
pressure .
its firstly discovered by French doctor named Lenik and it
was a wooden tube .
It is consist of : bell , diaphragm , and joint .
it gives the identity of the doctor .
Sphygmomanometer and sphygmomanometer cuff :
mercury monometer for measuring blood pressure .
consist of : rubber bag , air bladder , column of mercury ,
chamber of mercury
consider the best and the most accurate device to measure the
blood pressure .
grading is from( 0 - 300 mmHg ) .
the outer arm circumflex is ( 25 40 cm ) for adult regular
( standard : neither obese nor thin ) .
Regarding the cuff , the length = 50 cm , width = 12 - 15 cm
( for obese it should be longer and shorter for child and thin
people ) .
Air bladder is made from rubber ( inflated ) .

Steps of measuring :
1. Choose either sitting , semi sitting or supine position .
2. Identify the pulse of brachial artery as follow :
flex the forearm against resistant to feel the tendon of biceps
muscle
by using middle and index finger ( not thumb ) palpate the
brachial artery , medial to the tendon
notes :
some times no pulse can be felt because the bifurcation
occur above the cubital fossa , so we should turn to the
other arm .
brachial artery is a continuation of axillary artery which
come from subclavian artery and it continues as radial and
ulner arteries.
3. Palpate the radial pulse and inflate till the pulse disappear to
determined nearly the systolic blood pressure .
4. Put the stethoscope on the artery site and the tubes of
sphygmomanometer lateral to it .
5. Inflame the bladder by using the bulb to rise the column of
mercury to a level slightly higher palpatory systolic BP .
6. Descend the mercury 5 mmHg in each second .
7. Determine the systolic pressure at the level of first sound you
begin to hear , and diastolic pressure at the level of last sound
you hear before disappear .
Notes :
the direction of headphone should be away from you .
try to put the chest piece of stethoscope between the
index and the middle fingers .

Clinical notes
Normal Systolic blood pressure : 90 - 140 mmHg
Normal Diastolic blood pressure : 60 - 90 mmHg

Factors affecting blood pressure includes : age , gender , exercise ,

eating , time of day , disease status , . . . etc
thyrotoxicosis lead to S . hyper tension , why ?
due to sympathetic over activity because the thyroxin increase the
sensitivity of beta receptors to catecholamine's
systolic Blood pressure can influenced by non organic causes such :
renal artery stenosis ( increase rennin secretion from macula
densa cells )
Cushing syndrome
Cones syndrome ( increase aldosterone secretion from Z . F
of adrenal cortex )
Phaochromocytoma
chronic interstitial kidney disease
traumatic kidney
such types of hypertension usually resistant to drug therapy so they
are surgically corrected , e . g : by nephroctomy or adrenoctomy .

Vital sings ___________ lecture 2

2. Respiratory rate :

Normal respiratory rate 12 ( or16 ) - 20 cycle / min

you must measure R . R in one minute .

when you get older ,the respiratory rate decreased .

the male respiration is abdominal ( diaphragmatic ) while female

respiration is thoracic .

definitions
Dysnea : difficulty in breathing which may be :
exertional : occur during exercise .
orthopnea : occur at lying down position .
paroxysmal nocturnal dysnea : occur at the night
Tachyapnea : is increase in respiratory rate .
Apnea : complete absence of breathing
chyne stoke breath : it is a period of hyperapnea followed by apnea
such in head injury and severe pneumonia . mechanism ?
increase CO2 stimulate resp . ceneter Hyper ventilation
washing CO2 apnea
kausmal breathing : such in uremia ( metabolic acidosis ) , and we
smell the odor of ammonia from their mouths .

3. Pulse rate
Normal rate depend on :
1. general health
2. age
For normal adult is ( 60 90 Beat per minute )
In athletics they can increase the stroke volume and cardiac output
during doing sever exercise without large increase in heart rate ,
also there skeletal muscle depend on free fatty acid as a source of
energy rather than glucose .
The P. R decreased with age , the child has a high pulse rate
( 140 -150 bpm ) .
Causes of increase PULSE RATE :
1. Tachycardia with block
2. flutter
3. fibrillation
4. SVT
5. thyrotoxicosis
Pulse sites :
1. RADIAL : on the lateral of the wrist .
2. FEMORAL : at the mid - inguinal point , halfway between the pubic
symphysis and anterior superior iliac spine .
3. Popliteal : Above the knee , midline in the popliteal fossa .
4. Dorsalis pedis : on top of the foot , lateral to tendon of the extensor of
hallucis longus .
5. post . tibial pulse : located on the medial side of the ankle , 2 cm
inferior and 2 cm posterior to the medial malleolus .
6. CAROTID PULSE : below the angle of the mandible
Notes :
1. pulse rate should measured in one minute .
2. Pulse volume reflect the stroke volume , so low volume
( thready pulse) occurs in hypovolemia such in hypovolimic
shock .
3. the pulse either regular or irregular .

4. Body temperature :
Thermometer : It is a device use to measure body temperature ,
triangular in shape , has sharp edge which is numbered from ( 35 41 c ) and plant edge which is opaque . also there is the time in
which we measure ( 0.5 , 1 , 2 min ) if there is no time we measured
in 2 min, also there is a chamber of mercury , from it the silver
Colum ( mercury ) rise .
Put the sharp edge in front of your eyes , with slight rotatory
movement you can read the measurement .
not touch the thermometer from the chamber
Body temperature above 42 c is not compatible with life due to
denaturation of cellular enzyme ,while bellow 35c , intracellular
crystal occur , but the real hypothermia is bellow 27c
some times the surgeon use hypothermia in certain procedure
such in long time operation he induce ischemia to the organ
such in organ transplant or in hepatic resection to get blood
less field .
Normal body temperature depend on the site of measurement ,
oral , axillary or rectal
1. Oral body temperature ( 36.6 37.2 c )
2. Axillary body temperature is oral minus 0.5 c
3. Rectal body temperature is oral plus 0.5 c
EX : IF ORAL
RECTAL = 38.5

= 38 SO AXILLARY = 37.5 WHILE

From 37.2 39 C is fever or pyrexia

Above 39 C is hyperpyrexia or hyperthermia
From 35 - 36.6 C subnormal body temperature
Bellow 35 C is hypothermia

 Conditions lead to subnormal body temperature :

1. hypovolimic shock
2. rupture ectopic pregnancy
3. concealed bleeding as in rupture splenomegaly or rupture of
aortic aneurysm .
4. appendicitis
5. perforation
6. intestinal obstruction