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Lessons · Medicine foundations · a vital-signs round, in order

A vital-signs round, in the order it is done

Hand hygiene and an introduction, then temperature, pulse, respirations, blood pressure, oxygen saturation, and finally every value written down with its unit and the time.

Hone is a place to practise a career, one idea a day. This is one of its lessons, written out in full and free to read without an account.

What it is for

The reason respirations come straight after the pulse is not tidiness: a person who knows you are counting their breathing breathes differently. Keeping your fingers on the wrist and counting without saying so is a piece of technique hidden inside what looks like a list.

How to think about it

Learn the order as a single run so your hands do it while your attention is on the person. Count the pulse for a full minute rather than fifteen seconds times four, because a fifteen-second count multiplies any irregularity by four. Then record: a value with no unit and no time is not a record.

Worked example

Perform hand hygiene and introduce yourself
Before anything is touched.
Measure the temperature
First, because it needs the least handling.
Count the pulse for a full minute
A full minute, not a quarter of one multiplied up.
Count the respirations while still holding the wrist, without announcing it
Counted unobserved, or the number changes as you count it.
Measure the blood pressure
Cuff on a bare upper arm, at heart level.
Measure the oxygen saturation
A reading needs a good trace before it is a reading.
Write every value down with its unit and the time it was taken
A number with no time on it cannot be compared with the next one.

Your turn

Write the measurement the respirations are counted straight after, with your fingers still on the wrist.

Count the respirations straight after the , without announcing it.

The trap

Saying out loud that you are about to count the breathing. The rate changes the moment the person knows, and the number you write down is then a number about being watched rather than about them.

Practise a vital-signs round, in order on HoneA question on it now, a coding challenge where there is one, and it is remembered for review. Free, no email needed.