ER 101

Vital Signs

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The first step in getting you treated in an emergency room is testing your vital signs. It is helpful for the doctor if you know what your “normal” vital signs are.  For example, if your blood pressure is always a little low, say 102/60, this information is helpful for those individuals caring for you.   Know what the pros know.

  1. Blood pressure or BP: the force exerted in the arteries by blood as it circulates; it’s the ratio of systolic (when the heart contracts) and diastolic (when the heart relaxes and fills pressures. Normal: near 120/80).
  2. Heart rate: the speed of your pulse, measured in beats per minute.  Normal: 60-100. 
  3. Respiratory rate: measured by observing the number of times the chest rises and falls in a 60-second period. Normal: 12-16 breaths per minute.
  4. Temperature or temp: measures how hot your body is. Normal: 98.6°F (37°C); greater than 100.4°F (38°C) is considered a fever.

Taking Your Temp 

Mother Taking TempA fever may indicate emergency care is needed. Learn how to best take your temp and what it means.

Orally. Your temperature can be taken by mouth using a glass or digital thermometer. This method is best for adults and children who are able to do so.  Some glass thermometers contain mercury (the silver-colored liquid in the thermometer), which is a toxic and dangerous to humans and the environment. Glass thermometers containing mercury are no longer recommended. According to The Environmental Protection Agency (EPA), you must dispose of a mercury thermometer in accordance with local, state, and federal laws. Contact your local health, waste disposal or fire department to learn how. If the glass breaks, do not touch or in particular, vacuum the mercury—call your local poison control center immediately.

Rectally. You can use a glass of digital thermometer to take a temperature rectally. This method is best for infants under the age of two. Temperatures taken rectally tend to be 0.5 - 0.7° (Fahrenheit) higher than when taken orally.

Axillary. Tthis method is inaccurate and not relied upon by health care workers.  Using a glass or digital thermometer, place it in the armpit. This method is best used on teens and adults, but it is the longest and most inaccurate way of measuring a temperature. Temperatures taken this way tend to be 0.3 - 0.4° (Fahrenheit) lower than those taken orally.

Aurally. A special thermometer placed in the ear measures the temperature of the eardrum, which indicates your body's core temperature. This method can be used on anyone over the age of 6 months-old and is the quickest way to measure a temperature. 

Temporally.  This is a newer method where a device is swiped across the forehead to the temporal area of the scalp (to the side of the eye).  It measures the temperature of the blood vessels supplying the skin to that area.  It is accurate up to around 99.7° (Farenheit).  A temperature higher than that should be rechecked with either the oral or rectal method of taking a temperature.  

Things to Keep in Mind

You want to make sure to get the most accurate temperature reading possibile. So be sure to:

  • Follow the instructions that come with the thermometer.
  • Keep your mouth closed around the thermometer when taking your temperature orally.
  • Keep the thermometer in place long enough.
  • Avoid hot or cold liquids within 30 minutes of taking your temp.

Degrees of Meaning
A fever is one of the results of the body trying to fight an infection. If you or your family member has a cold or stomach flu, it is likely that you will also have a fever too.  The fact that a fever is present, by itself, is not usually worrisome but rather a manifestation that there is an infection of some type present in the body. 

A fever can make someone feel miserable and make children not want to drink or eat.  In order to make a person more comfortable, a fever can be treated.  Remember to use only ibuprofen or acetaminophen to treat fever; avoid aspirin products for the treatment of fever as there is the potential of damaging the liver by using aspirin for this reason alone. Also, do not place small children in cold baths as this can cause a dangerous drop in their body temperature.  Similarly, fever in children should not be treated by using rubbing alcohol on their skin as they can absorb this and become poisoned from this liquid. 

When should you go to the Emergency Department for a fever? 

  • Small babies under the age of 3 months-old.
  • If you are a senior citizen with a fever.
  • People who have cancer who are undergoing chemotherapy.
  • If you have certain medical problems which make you immunocompromised (i.e. diabetes, sickle cell disease, HIV,etc.)
  • If you are taking steroids long-term.
  • If the fever lasts for more than 4-5 days.
  • If the fever is really high (104° Farenheit). 
  • If the person with the fever looks really ill or has trouble breathing, a change in their behavior, headache or neck stiffness.  

Put Your Finger on the Pulse

Man Taking PulseTo take your pulse, firmly, but gently, press your index and middle finger on the artery at either lower neck, inside your elbow or inside your wrist. When taking your pulse:

  • Have a watch with a second hand or a stopwatch so you will know how many beats you count in a minute.
  • Start counting the beats when the second hand is on the 12 or when you start your stopwatch.
  • Count the beats in a 60-second period. Or, you can count the beats in a 15-second period and multiply that number by four.
  • Take your pulse at least twice to get an accurate reading.
  • If you are having trouble feeling your pulse, ask another person to count for you.

Below is the American Heart Association’s (AMA) target heart rate chart by age, which is to be used as a guideline.

Age

Target HR Zone
50–85 %

Average Maximum
Heart Rate
100 %

20 years

100–170 beats per minute

200 beats per minute

25 years

98–166 beats per minute

195 beats per minute

30 years

95–162 beats per minute

190 beats per minute

35 years

93–157 beats per minute

185 beats per minute

40 years

90–153 beats per minute

180 beats per minute

45 years

88–149 beats per minute

175 beats per minute

50 years

85–145 beats per minute

170 beats per minute

55 years

83–140 beats per minute

165 beats per minute

60 years

80–136 beats per minute

160 beats per minute

65 years

78–132 beats per minute

155 beats per minute

70 years

75–128 beats per minute

150 beats per minute

Courtesy of the American Heart Association

The AMA notes that a few high blood pressure medications lower the maximum heart rate and, thus, the target zone rate. If you're taking these types of medicine, call your physician to find out if you need to use a lower target heart rate.

 

Blood Pressure Pressures

Blood Pressure CuffUnderstanding your blood pressure is critical to your health.

There are two numbers used in measuring blood pressure. The high number is known as systolic pressure. The lower number is known as diastolic pressure. Both of the numbers are recorded as "mm Hg" (millimeters of mercury).

High blood pressure (or hypertension) is when the systolic number is equal to or higher than 140 and the diastolic number is equal to or higher than 90. High blood pressure increases the risk of coronary heart disease and stroke.

And while high blood pressure can occur in children and adults, it is more common for those over 35. It is also prevalent in African Americans, obese people, smokers, heavy drinkers, elderly people, women taking birth control pills and those who eat a diet high in fatty and salty foods.

If your blood pressure is extremely high and you are experiencing  one or more of the following, contact your primary car physician or go to your local emergency room:

  • Chest pain
  • Difficulty breathing
  • Irregular heartbeat
  • Severe headache
  • Fatigue or confusion
  • Vision problems
  • Blood in the urine

Low Blood Pressure (or hypotension) if you feel fine and are able to get up and do your normal activities without difficulty,  then there is usually no level at which blood pressure is considered too low. ,ronic low blood pressure is almost never serious, but should be checked out by your primary care physician.

A sudden drop in blood pressure, however, can be life-threatening. If you experience a drop in blood pressure due to low or high body temperature, dehydration, bleeding or an allergic reaction, go to your local emergency department immediately. 


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