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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Vital signs are measures of various physiological statistics often taken by health professionals in order to assess the most basic body functions. Vital signs are an essential part of a case presentation.

Primary four

There are four vital signs which are standard in most medical settings:

  1. Body Temperature
  2. Pulse rate (or heart rate)
  3. Blood pressure
  4. Respiratory rate

The equipment needed is a thermometer, a sphygmomanometer, and a watch with a second hand.

Though a pulse can often be taken by hand, a stethoscope may be required for a patient with a very weak pulse.

Additional signs

Fifth sign

The phrase "fifth vital sign" usually refers to pain, as perceived by the patient on a Pain scale of 0-10. For example, the Veterans Administration made this their policy in 1999. However, some doctors have noted that pain is actually a subjective symptom, not an objective sign, and therefore object to this classification.[1]

Other sources include pulse oximetry as their fifth sign.[2][3][4]

Some sources consider pupil size, equality, and reactivity to light to be a vital sign as well.[5]

Sixth sign

There is no standard "sixth vital sign", and the use is much more informal and discipline-dependent than with the above, but some proposals (excluding the fifth sign candidates above) include:

Variations by age

Children and infants have respiratory and heart rates that are faster than those of adults as shown in the following table:

Age Normal heart rate
(beats per minute)[12]
Normal respiratory rate
(breaths per minute)[13]
Newborn 200-260 30-50
0-5 months 90-190 25-40
6-12 months 80-140 20-30
1-3 years 80-130 20-30
3-5 years 80-120 20-30
6-10 years 70-110 15-30
11-14 years 60-105 12-20
14+ years 60-100 12-20

See also


  1. Harold S. Lee. November 2004. Physical Diagnosis 101: A Lesson From the First Year of Medical School, in Letters to the Editor. American Society of Anesthesiologists, Volume 68, Number 11.
  2. Mower W, Myers G, Nicklin E, Kearin K, Baraff L, Sachs C (1998). "Pulse oximetry as a fifth vital sign in emergency geriatric assessment". Acad Emerg Med. 5 (9): 858–65. PMID 9754497.
  3. Mower W, Sachs C, Nicklin E, Baraff L (1997). "Pulse oximetry as a fifth pediatric vital sign". Pediatrics. 99 (5): 681–6. PMID 9113944.
  4. Neff T (1988). "Routine oximetry. A fifth vital sign?". Chest. 94 (2): 227. PMID 3396392.
  5. Daniel Limmer and Michael F. O'Keefe. 2005. Emergency Care 10th ed. Edward T. Dickinson, Ed. Pearson, Prentice Hall. Upper Saddle River, New Jersey. Page 212 and 218.
  6. Joseph A (2003). "Continence: the sixth vital sign?". Am J Nurs. 103 (7): 11. PMID 12865635.
  7. Vardi A, Levin I, Paret G, Barzilay Z (2000). "The sixth vital sign: end-tidal CO2 in pediatric trauma patients during transport". Harefuah. 139 (3–4): 85–7, 168. PMID 10979461.
  8. Bultz B, Carlson L (2006). "Emotional distress: the sixth vital sign--future directions in cancer care". Psychooncology. 15 (2): 93–5. PMID 16444764. link
  11. Bierman A (2001). "Functional status: the sixth vital sign". J Gen Intern Med. 16 (11): 785–6. PMID 11722694. link
  12. Emergency Care, Page 214
  13. Emergency Care, Page 215


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