Assessment Of Vital Signs Research Articles

Assessment of vital signs in the child

An assessment of an individual's vital signs—temperature, pulse, respirations, and blood pressure (BP)—gives an overview of his or her general health. These measures, which indicate the effectiveness of circulatory, respiratory, and neural body functions, offer a quick and efficient way to monitor a child's condition, identify problems, and evaluate the response to interventions. Therefore, it is imperative that the home care provider accurately assess these values. This article will review key principles in assessing vital signs in the child.

A multicenter evaluation of the efficacy and safety of 150 and 300 mg/d sustained-release bupropion tablets versus placebo in depressed outpatients

This multicenter, randomized, double-masked, placebo-controlled, parallel-group study compared the antidepressant efficacy and safety of bupropion sustained-release (SR) tablets (150 mg QD or 150 mg BID) with placebo in outpatients with moderate-to-severe depression. The study consisted of a 1-week placebo phase followed by 8 weeks of active treatment with bupropion SR 150 mg/d (150 mg QD, n = 121) or 300 mg/d (150 mg BID, n = 120) or placebo (n = 121). Efficacy was measured by changes in scores on the 17-item Hamilton Rating Scale for Depression (HAM-D) and the Clinical Global Impressions for Severity of Illness (CGI-S) and Clinical Global Impressions for Improvement of Illness (CGI-I) scales. Safety was monitored by regular assessment of vital signs and adverse events as well as by pretreatment and posttreatment physical and clinical laboratory examinations. By day 56, both bupropion SR treatments were more effective in relieving the symptoms of depression than was placebo. Compared with those receiving placebo, patients in the bupropion SR 150- and 300-mg/d groups had significantly reduced symptoms by treatment day 56, as measured on the 17-item HAM-D, CGI-S, and CGI-I scales ( P < 0.05). Bupropion SR was well tolerated, with no serious adverse events reported by bupropion-treated patients; 95% of all reported adverse events were of mild or moderate intensity. No clinically significant changes in vital signs, laboratory test results, or physical findings were observed. A greater mean weight loss was observed at the end of treatment in both the bupropion SR 150-mg (0.5 kg) and bupropion SR 300-mg (1.0 kg) group compared with placebo (0.2 kg). We found that bupropion SR 150 mg administered either once or twice daily was more effective than placebo in treating depression and that once-daily dosing appears to be at least as effective as twice-daily dosing. Should this prove true, depressed patients may be able to benefit from the convenience and improved tolerability associated with once-daily dosing.

Effect of vital signs on advanced life support interventions for prehospital patients

Objective. Routine vital signs assessment is considered a fundamental component of patient assessment. This study was undertaken to determine whether advanced life support (ALS) emergency medical services (EMS) providers depend on vital signs information in managing their patients.Methods. Emergency medical technician-paramedics (EMT-Ps) and EMT-Intermediates (EMT-Is) were presented with 20 randomized patient scenarios that did not included vital signs information. The participants were asked to identify all of the interventions they would perform for each hypothetical patient. At least six weeks later the same scenarios were presented in a new order, with vital signs information, and the participants again identified the interventions they would perform. The participants' estimations of the patients' blood pressures, as well as the frequencies with which 18 specific interventions were performed, were compared for the no-vital signs and the vital signs groups using chi-square or Fisher's exact test, with an alpha value of 0.05 considered significant.Results. Fourteen EMT-Ps and 16 EMT-Is completed both the no-vital signs and vital signs portions of the study, for a total of 1,160 hypothetical patient encounters. When vital signs were given, the EMT-Is were more likely to apply a cardiac monitor (65.2% vs 80.1%, p = 0.000), more likely to start at least one intravenous (IV) line (82.1% vs 87.8%, p = 0.038), and more likely to administer a medication (1.3% vs 5.6%, p = 0.003). The EMT-Ps were also more likely to apply a cardiac monitor (84.4% vs 90.3%, p = 0.041), more likely to run an IV at a “wide open” rate (9.5% vs 19.0%, p = 0.004), and less likely to identify patients as being hypotensive (39.9% vs 26.4%, p = 0.004).Conclusion. The presence or absence of vital signs information does influence some of the patient care decisions of EMS providers; however, the clinical implications of these decisions are unclear. Further studies are needed to determine whether ALS providers can adequately manage actual patients without obtaining vital signs.

Poster 011. Do ALS Providers Need Vital Signs to Assess and Manage Prehospital Patients?

Purpose: Routine vital signs (VS) assessment is considered a fundamental component of patient assessment. This study was undertaken to determine if advanced life support EMS providers can manage patients without VS. Methods: Twenty-seven paramedics and 37 intermediates were presented with 20 randomized patient scenarios that did not include VS. They were asked to identify all interventions they would perform for each patient. Six weeks later, the same scenarios were presented in a new order, with VS, and the participants again identified the interventions they would perform. The frequency of specific interventions for each patient in the no-VS group was compared to the frequency in the VS group using chi-square or Fisher's Exact test. Results: There were two cases for which paramedics significantly changed their interventions when given VS. They were more likely to run IVs wide open in an unresponsive 86-year-old woman with an unobtainable blood pressure ( p = 0.024), and less likely to immobilize a 65-year-old man who had fallen the night before ( p = 0.001). There were three cases for which intermediates significantly changed their interventions when given VS. They were more likely to start two IVs for a 69-year-old with near syncope ( p = 0.020), less likely to run IVs wide open for a 32-year-old gunshot victim ( p = 0.016), and they, too, were less likely to immobilize the 65-year-old man who had fallen the night before ( p = 0.013). Conclusion: Vital signs do not significantly affect interventions for most prehospital patients, and may not be necessary.

Analgesic efficacy and safety of tramadol enantiomers in comparison with the racemate: a randomised, double-blind study with gynaecological patients using intravenous patient-controlled analgesia

The opioid analgesic tramadol is a racemate and consists of 50% (+)- and 50% (−)-enantiomer. This study investigated analgesic efficacy and safety of both enantiomers after intravenous (i.v.) injection in comparison with the racemate. Ninety-eight patients recovering from major gynaecological surgery under opioid-free halothane anaesthesia were treated in a randomised, double-blind study with (+)-tramadol, (−)-tramadol or the racemate. Following an individualised i.v. loading dose up to a maximum of 200 mg, patient-controlled analgesia with demand doses of 20 mg was made available for 24 h. The primary criterion of efficacy was the decrease of pain intensity on a 5-point verbal rating scale from severe or maximum pain to mild or no pain within the first hour after the loading dose. The secondary criterion was patient satisfaction with pain relief during the 24-h observation period stated in the final interview. Patients who terminated the study prematurely were evaluated as non-responders. Of patients treated with (+)-tramadol, tramadol racemate, and (−)-tramadol, 12%, 15% and 53% of treated patients, respectively, terminated the study prematurely because of inefficacy. Of patients treated with (+)-tramadol, racemate or (−)-tramadol 67%, 48% and 38%, respectively, were considered responders regarding the primary criterion of efficacy ( P = 0.061), and 82%, 76% or 41% with respect to the secondary criterion ( P = 0.001). Assessment of laboratory screening, adverse events, vital signs and blood gas monitoring showed no serious drug-related events. Nausea and vomiting were the most frequently reported non-serious side effects and were most often seen with (+)-tramadol. Taking into account both efficacy and safety aspects, the racemate seems to be superior to either enantiomer alone.

Amphetamine effects on recovery sleep following total sleep deprivation

AbstractNormal, healthy adult males participated in a sleep deprivation study during which periodic assessments of mood, alertness, cognitive performance, and vital signs were made. After 48 hours of continuous wakefulness, placebo or d‐amphetamine (5, 10, 20 mg) was administered orally in a double‐blind fashion. Assessments continued for an additional 14 hours at which time the subjects were allowed to sleep. A significant difference in total sleep time was observed with the highest amphetamine group (20 mg) averaging 7·0 hours vs. 8·1 hours for the placebo group. The decrease in total sleep time was due largely to a significant decrease in REM time. The number of REM episodes was not affected by drug. Latency to the first REM episode was decreased by the 5 and 10 mg dose but unchanged by the 20 mg dose of amphetamine. Amphetamine's significant effects on total sleep time and other parameters more than 15 hours after administration indicate a prolonged drug effect.

Nitrous Oxide Analgesia-Reply

In Reply.— This letter raises several points that deserve further elaboration. There is no doubt that patients who have undergone treatment for cancer have a variety of complex medical problems, including myocardial dysfunction. In our opinion, once it has been established that a patient in severe pain is near death, treatment of pain becomes the overriding issue despite any concurrent medical problems. The approach to pain control will vary depending on circumstances, and it is clear that any intervention, including epidural analgesia or anesthesia as well as nitrous oxide, will have potential complications. We have proposed that nitrous oxide analgesia is one way of treating intractable pain that deserves consideration. In our experience, cardiovascular side effects were not obvious and patients' moods and level of consciousness improved rather than diminished. Since our end point is patient comfort rather than physiological stability, we believe that repeated assessment of vital signs is