Blood Pressure, Pulse and Temperature Parameters

Table of Contents

Blood Pressure, Pulse and Temperature: Vital Sign Parameters

Detailed emergency medical care notes for EMT students

Why this topic matters: Blood pressure, pulse and temperature are not isolated numbers. They are physiological signals that describe perfusion, cardiac output, vascular tone, thermoregulation and the patient’s response to illness or treatment. In emergency care, the trend and the relationship between observations often matter more than a single reading. An accurate measurement can reveal shock, infection, haemorrhage, dysrhythmia, medication effect, heat illness or hypothermia before the patient becomes visibly critical.

Learning outcomes

Define blood pressure, pulse and body temperature and explain their physiological importance.
Identify common adult reference parameters while recognising age, pregnancy, activity, environment and illness-related variation.
Select, prepare and use appropriate equipment for manual and automated blood pressure, pulse and temperature measurement.
Describe accurate step-by-step techniques and the common errors that produce false readings.
Interpret rate, rhythm, strength, equality, systolic pressure, diastolic pressure, pulse pressure and temperature patterns in context.
Recognise emergency patterns such as shock, severe hypertension, dysrhythmia, fever, hypothermia and deterioration.
Document, trend, reassess and communicate vital observations safely during prehospital care and handover.

1. What are vital signs?

Vital signs are measurable indicators of essential body functions. The traditional vital signs are temperature, pulse, respiratory rate and blood pressure; oxygen saturation, level of consciousness, pain and blood glucose are also routinely added to emergency assessment. This post focuses on blood pressure, pulse and temperature. Respiratory assessment is covered in the separate respiration lesson.

Vital signs answer three practical questions: How sick is the patient now? Is the condition changing? Is treatment helping? They must be interpreted alongside appearance, symptoms, history, physical findings and the quality of the measurement.

Emergency principle: Treat the patient, not the monitor. A normal number from a poorly positioned cuff or a cold fingertip can be misleading; a patient who looks shocked or deteriorates requires immediate reassessment and escalation.

2. Reference parameters and important cautions

Reference ranges are guides, not diagnostic boundaries. Age, fitness, pregnancy, pain, anxiety, medications, fever, exercise, dehydration, chronic disease, altitude and measurement site can change the expected value. WHO’s emergency-unit reference card lists typical adult values of pulse 60–100 beats/minute, respiratory rate 10–20/minute, temperature 36–38°C and systolic blood pressure above 90 mmHg, but local protocols and clinical context must be followed.

Observation	Common adult reference guide	Always interpret with
Pulse	About 60–100 beats/minute at rest.	Rhythm, strength, equality, age, fitness, fever, pain, drugs and perfusion.
Blood pressure	Often around 90/60 to 120/80 mmHg in healthy adults; WHO emergency screening uses systolic >90 mmHg as a general reference.	Symptoms, perfusion, baseline, bleeding, sepsis, pregnancy and trend.
Temperature	Approximately 36–38°C, depending on site and circumstances.	Measurement site, time of day, exposure, infection, heat illness and medication.
Pulse pressure	Systolic minus diastolic pressure; around 40 mmHg is a common resting example.	Stroke volume, arterial stiffness, shock and the complete blood pressure.

Do not diagnose hypertension, shock or infection from one unverified value. Repeat an unexpected result, confirm the method and assess the patient immediately.

3. Why trends are more useful than isolated numbers

Pattern	Possible meaning	Action for the EMT
BP falling, pulse rising, skin becoming cool	Possible blood loss, dehydration, sepsis or deteriorating shock.	Reassess ABCs and bleeding, treat within scope, escalate and expedite transport.
Temperature rising with increasing pulse	Infection, inflammation, heat illness or another stress response.	Look for source, perfusion, altered consciousness and sepsis/heat-risk signs.
Pulse slowing with worsening consciousness	Possible hypoxia, medication effect, raised intracranial pressure or terminal deterioration.	Repeat primary survey, glucose and neurological assessment; call for urgent support.
BP high during pain, then falling after treatment	Stress response may have contributed, but a dangerous cause is not excluded.	Trend after rest and treatment; investigate symptoms and risk factors.
Numbers inconsistent with appearance	Technique, equipment, dysrhythmia or rapid change may be involved.	Repeat manually or with a validated alternative and verify circulation.

4. Preparation for accurate vital-sign measurement

Perform hand hygiene and introduce yourself; explain what you are measuring.
Check scene safety, patient identity, privacy and the need for immediate resuscitation.
Position the patient appropriately, support the body part and expose only what is necessary.
Allow quiet rest when the clinical situation permits; pain, talking, recent activity, smoking, caffeine, shivering and anxiety can alter values.
Use equipment that is clean, functional, correctly sized and validated or calibrated according to service policy.
Check the device, cuff, thermometer probe cover, watch/second hand and stethoscope before starting.
Record the time, position, site, oxygen or medications in use and any factors that may influence the result.

5. Equipment for blood pressure, pulse and temperature

Equipment	Purpose	Checks before use
Sphygmomanometer	Measures arterial pressure with an inflatable cuff and manometer.	Correct cuff, intact tubing, zeroed gauge, functioning bulb and valve.
Stethoscope	Allows auscultation of Korotkoff sounds during manual BP measurement.	Clean earpieces/diaphragm, comfortable fit and no air leaks.
Automated BP monitor	Uses oscillometry to estimate systolic, diastolic and pulse rate.	Validated device, correct cuff, charged battery and no movement during cycle.
Watch or timer	Counts pulse for a measured period.	Readable seconds, synchronised time and clean hands.
Thermometer	Measures temperature at an approved site.	Correct probe, disposable cover, battery, cleaning and site-specific instructions.
Observation chart/ePCR	Records values, trends, interventions and escalation.	Patient identifier, units, time and clear notation of abnormal findings.

6. Blood pressure: definition and physiology

Blood pressure (BP) is the force exerted by circulating blood against arterial walls. It depends on cardiac output, vascular resistance, circulating volume, arterial elasticity and neurohormonal control.

Systolic blood pressure (SBP): the peak arterial pressure during ventricular contraction.
Diastolic blood pressure (DBP): the lowest arterial pressure during ventricular relaxation and filling.
Pulse pressure: SBP minus DBP. For 120/80 mmHg, pulse pressure is 40 mmHg.
Mean arterial pressure (MAP): an approximate average driving pressure; at normal rates, MAP is commonly estimated as DBP + one-third of pulse pressure.
Perfusion: blood flow to tissues; BP is one clue, but mental status, skin, pulse, urine output and capillary refill add important information.

Remember: A blood pressure is written as systolic over diastolic, for example 120/80 mmHg. Always include the unit, arm/site, position and time when documenting.

7. Preparing a patient for BP measurement

Use a quiet environment when possible and allow the patient to rest for about five minutes if urgency permits.
Ask the patient not to talk, laugh, use a phone or move during the reading.
Seat the patient with back supported, feet flat, legs uncrossed and arm relaxed on a surface at heart level. In an emergency, document if the patient is lying, standing or unable to cooperate.
Place the cuff on bare skin of the upper arm; do not wrap it over clothing or a rolled sleeve that constricts the arm.
Use the correct cuff size based on arm circumference. A cuff that is too small commonly gives a falsely high reading; one that is too large may give a falsely low reading.
Avoid an arm with an infusion, dialysis fistula, mastectomy-side restriction or injury when an alternative is available; follow local policy.

8. Manual blood pressure measurement

Position and support the patient’s arm with the palm facing upward; locate the brachial artery in the antecubital fossa.
Wrap the cuff snugly around the upper arm with the lower edge about 2–3 cm above the elbow crease and the artery marker over the brachial artery.
Place the stethoscope diaphragm over the brachial artery without placing it under the cuff or pressing excessively.
Estimate the inflation level by palpating the radial pulse while inflating until the pulse disappears; add approximately 30 mmHg to avoid missing an auscultatory gap, according to training and equipment guidance.
Release pressure gradually, commonly about 2–3 mmHg per second, while listening over the brachial artery.
Record the pressure at the first consistent Korotkoff sound as SBP.
Continue deflation until the sounds disappear or reach the locally specified endpoint; record the appropriate diastolic value.
Fully deflate, remove the stethoscope and allow the patient to rest before repeating if the result is unexpected or clinically important.
Record the arm, position, cuff size, time, reading and patient condition.

Korotkoff sounds: The first clear repetitive tapping sound is used for systolic pressure. The disappearance or designated final phase of sound is used for diastolic pressure according to the local standard, patient group and equipment.

9. Automated blood pressure measurement

Choose the correct cuff and apply it to the bare upper arm with the artery marker correctly aligned.
Position the arm at heart level and keep the patient still and silent.
Start the monitor and observe the patient rather than walking away during an abnormal or symptomatic reading.
Repeat the measurement if the device displays an error, the patient moves, the rhythm is irregular or the result conflicts with the clinical picture.
Confirm unexpectedly high or low values by manual measurement or an approved alternative when feasible.
Do not interpret an automated “error” as a normal BP; troubleshoot cuff position, movement, perfusion and device function.

10. Cuff size and position errors

Error	Likely effect	Correction
Cuff too small	Often falsely high BP.	Measure arm circumference and use the correct adult, large adult, thigh or paediatric cuff.
Cuff too large	May produce a falsely low reading.	Use a cuff whose bladder fits the arm according to manufacturer range.
Cuff over clothing	Unreliable pressure transmission.	Expose the upper arm while protecting dignity and warmth.
Arm below heart level	Reading may be falsely high.	Support the cuffed arm at heart level.
Arm unsupported or patient talking	Reading may rise or vary.	Support the arm, rest the patient and repeat quietly.
Legs crossed, back unsupported or bladder full	May increase the reading.	Correct position where clinical circumstances allow and document limitations.
Deflation too fast	Can miss sounds and distort SBP/DBP.	Deflate slowly and steadily.
Irregular rhythm or movement	Automated estimate may be inaccurate.	Repeat, use manual technique if trained and interpret with pulse rhythm.

Correct positioning and cuff selection are not cosmetic details. The American Heart Association emphasises a supported arm at heart level, bare skin and an appropriately sized cuff for reliable readings.

11. Interpreting adult blood-pressure categories

Adult category for general classification	Systolic	Diastolic	Emergency teaching point
Normal	<120	and <80	Does not exclude acute illness; symptoms and trends still matter.
Elevated	120–129	and <80	Repeat correctly; do not label a patient from a single stressful reading.
Stage 1 hypertension	130–139	or 80–89	Requires follow-up, not automatic emergency treatment.
Stage 2 hypertension	≥140	or ≥90	Assess symptoms, repeat and refer according to local protocol.
Severely elevated	≥180	and/or ≥120	Repeat promptly and assess neurological, cardiac, renal and visual symptoms; emergency if end-organ symptoms are present.

These categories are adult outpatient classification aids, not a substitute for emergency assessment. Pregnancy, children, chronic hypertension, pain, seizures and acute injury require context-specific interpretation.

12. Hypotension and shock

Hypotension means blood pressure below the patient’s expected level or below a threshold used by local protocol. In emergency care, a falling BP may be late evidence of shock. A patient can have serious blood loss, sepsis or cardiogenic compromise while the BP still appears “normal,” especially early or in a previously hypertensive patient.

Possible cause	History clues	Associated findings
Haemorrhage	Trauma, vomiting blood, black stool, postpartum bleeding or surgery.	Fast weak pulse, pale/cool skin, delayed refill, anxiety, confusion and falling BP.
Dehydration	Diarrhoea, vomiting, heat, poor intake or excessive urination.	Thirst, dry mucosa, orthostatic symptoms, tachycardia and reduced urine.
Sepsis	Fever or low temperature, infection, wound, cough, dysuria or recent procedure.	Abnormal temperature, fast pulse, altered mentation, abnormal breathing and poor perfusion.
Cardiogenic cause	Chest pain, heart failure, arrhythmia or previous cardiac disease.	Breathlessness, crackles, cool skin, irregular pulse and weak perfusion.
Anaphylaxis	Recent food, medicine, sting or exposure.	Hives, swelling, wheeze, vomiting, collapse and low BP.

Action: Recheck the value, repeat the primary survey, control external bleeding, position and support the patient according to protocol, request additional help and arrange urgent transport. Never treat a number without looking for the cause.

13. Orthostatic blood pressure and pulse

Orthostatic observations compare measurements after rest and after a controlled change in position. They may help identify volume depletion or autonomic dysfunction, but they should not be performed in an unstable patient or when standing creates a fall risk.

Explain the procedure and obtain assistance; keep the patient safe from falls.
Measure baseline pulse and BP after rest, then repeat according to local protocol after sitting and/or standing.
Ask about dizziness, faintness, blurred vision, weakness or collapse.
Stop if symptoms or instability occur, return the patient to a safe position and escalate.
Document the position, time, symptoms and readings rather than simply writing “orthostatic positive.”

14. Paediatric, pregnancy and special BP considerations

Patient group	Important considerations
Infants and children	Use an age/size-appropriate cuff; crying, fear and movement may raise the reading. Interpret with age, height and local paediatric tables.
Pregnancy	Use correct cuff size and position; repeated high BP with headache, visual symptoms, upper abdominal pain, seizures or swelling needs urgent escalation.
Older adults	Consider postural symptoms, arterial stiffness, baseline hypertension and medication effects.
Trauma or burns	Avoid injured or burned limbs where possible; use an alternative site according to training and protocol.
Dialysis fistula or mastectomy	Respect restrictions and use the opposite limb if available; follow facility guidance.
Very low perfusion	Automated devices may fail; use clinical signs and manual/alternative methods while requesting advanced care.

15. Pulse: definition and physiology

The pulse is the pressure wave felt in an artery as the heart ejects blood. Pulse assessment provides information about heart rate, rhythm, strength and peripheral circulation. The pulse rate is related to heart rate but may be lower than the electrical or apical heart rate when some beats do not produce a palpable peripheral wave; this difference is a pulse deficit.

Pulse feature	What it means	How to describe it
Rate	Number of palpable beats per minute.	For example, 88 beats/minute.
Rhythm	Regularity and pattern of intervals.	Regular, regularly irregular or irregularly irregular.
Strength/volume	Amplitude of the pulse wave and peripheral perfusion.	Weak/thready, normal or bounding; use the service scale if available.
Equality	Comparison between corresponding sites or limbs.	Equal or unequal; note absent or delayed pulse.
Contour	Rise and fall of the wave, when clinically assessed.	Slow-rising, collapsing or otherwise abnormal according to training.

16. Pulse sites

Site	Location	Useful situation
Radial	Thumb-side wrist, lateral to the flexor tendon.	Routine adult pulse when circulation is adequate.
Carotid	Side of neck, between trachea and sternocleidomastoid.	Central pulse in an unresponsive adult; palpate one side at a time.
Brachial	Medial upper arm/antecubital area.	Infants, BP auscultation and assessment of upper-limb circulation.
Femoral	Groin at the mid-inguinal point.	Central perfusion and trauma assessment when appropriate.
Popliteal	Behind the knee.	Lower-limb circulation; can be difficult to locate.
Posterior tibial	Behind and slightly below the medial ankle.	Foot perfusion and comparison after lower-limb injury.
Dorsalis pedis	Top of the foot beside the extensor tendon of the great toe.	Distal foot circulation; may be naturally absent in some people.
Apical	Heart apex auscultated with a stethoscope.	Irregular pulse, infants, cardiac assessment or pulse deficit.

Safety: Never palpate both carotid arteries simultaneously. Avoid excessive pressure because it can reduce cerebral blood flow or stimulate a vagal response.

17. Procedure for radial pulse assessment

Position the patient comfortably with the arm supported and hand relaxed.
Use the pads of the index and middle fingers, not the thumb, because the thumb has its own pulse.
Place the fingers on the radial artery and apply gentle pressure until the pulse is clear.
Count for 30 seconds and multiply by two if the rhythm is regular and the patient is stable; count for a full 60 seconds when rhythm is irregular, rate is very fast/slow, or accuracy matters.
Assess rhythm, strength and equality with the opposite side when safe.
Record the rate, rhythm, strength, site, time and relevant symptoms.
Repeat after intervention, deterioration, exertion or a change in the patient’s complaint.

18. Apical pulse and pulse deficit

The apical pulse is heard over the heart with a stethoscope rather than felt at a peripheral artery. It is useful when the radial pulse is weak, irregular, difficult to palpate or inconsistent with the patient’s symptoms. When another trained clinician counts the apical and radial pulses simultaneously, the difference is the pulse deficit.

Use a quiet environment and place the stethoscope at the appropriate apical area according to training.
Count for a full minute when rhythm is irregular.
Compare the apical rate with a peripheral pulse if the patient is symptomatic or the rhythm is irregular.
Report a deficit, irregular rhythm, new tachycardia or bradycardia promptly.

19. Interpreting pulse rate

Finding	Term	Possible causes	Questions/assessment
Below expected adult resting rate	Bradycardia	Fitness, sleep, medications, conduction disease, hypothermia, hypoxia or raised intracranial pressure.	Is the patient symptomatic? Check BP, consciousness, breathing, temperature, medicines and ECG/advanced support if available.
Above expected adult resting rate	Tachycardia	Pain, fever, anxiety, dehydration, haemorrhage, sepsis, hypoxia, stimulant use or dysrhythmia.	Look for cause and perfusion; do not simply suppress the number.
Irregular rhythm	Irregular pulse	Atrial fibrillation, ectopics, variable conduction or severe physiological stress.	Count for 60 seconds, assess symptoms and compare apical/peripheral rate if possible.
Weak or thready	Low-volume pulse	Shock, low stroke volume, dehydration, arterial obstruction or severe heart failure.	Check central pulse, BP, skin, mental status, capillary refill and bleeding.
Bounding	High-volume pulse	Fever, exercise, anxiety, early sepsis, hyperdynamic states or some valve conditions.	Assess temperature, BP, perfusion and trend rather than diagnosing from pulse alone.

20. Pulse rhythm and dysrhythmia clues

Regular: intervals are equal; a regular rate does not guarantee a normal rhythm.
Regularly irregular: an irregular pattern repeats predictably, such as a premature beat after a regular interval.
Irregularly irregular: no predictable pattern; atrial fibrillation is one possible cause.
Pulse deficit: some cardiac contractions do not create a palpable peripheral pulse.
Unequal pulses: may suggest vascular obstruction, injury, dissection or normal anatomical variation; compare sides and escalate when new or symptomatic.

21. Pulse changes in common emergency patterns

Clinical pattern	Expected pulse clue	Other observations to seek
Haemorrhagic shock	Often rapid and weak, though late bradycardia may occur.	Bleeding, pale/cool skin, delayed refill, anxiety, confusion and falling BP.
Sepsis	Often tachycardia with fever or low temperature.	Infection source, altered mentation, abnormal breathing and poor perfusion.
Hypothermia	Early tachycardia; later slowing and irregularity.	Shivering or absence of shivering, cold skin, confusion and reduced consciousness.
Heat illness	Often fast and bounding initially.	Hot skin, altered behaviour, dehydration, collapse and high temperature.
Opioid or sedative effect	May be slow or normal despite dangerous respiratory depression.	Reduced consciousness, small pupils, slow/shallow breathing and cyanosis.
Cardiac dysrhythmia	Very fast, very slow or irregular.	Palpitations, chest pain, syncope, breathlessness and poor perfusion.

22. Temperature: physiology

Body temperature reflects the balance between heat production and heat loss, regulated mainly by the hypothalamus. Temperature changes may result from infection, inflammation, exercise, ambient temperature, dehydration, endocrine disease, neurological injury, medication, toxins or impaired thermoregulation.

Core temperature: the temperature of deeper tissues and organs; it is not always identical to a peripheral reading.
Fever: a regulated rise in the body’s temperature set point, commonly associated with infection or inflammation.
Hyperthermia: excessive heat accumulation without a regulated set-point change, as in heat stroke or some drug syndromes.
Hypothermia: abnormally low core temperature, conventionally below 35°C in adults.

Clinical warning: Absence of fever does not exclude serious infection, especially in older adults, neonates, immunosuppressed patients or advanced sepsis. A low temperature can be an equally serious sign.

23. Temperature measurement sites and methods

Site/method	Advantages	Limitations and precautions
Oral	Convenient and reasonably representative in cooperative patients.	Recent hot/cold drinks, mouth breathing, oxygen, vomiting, oral injury and inability to cooperate affect accuracy.
Axillary	Non-invasive and useful when oral measurement is unsuitable.	May read lower and be more affected by position, sweat and poor contact.
Tympanic	Fast and close to core temperature when positioned correctly.	Ear canal obstruction, incorrect angle, device technique and ambient conditions affect results.
Temporal/forehead	Quick and useful for screening.	Sweat, cold environment, head covering and device limitations may reduce accuracy.
Rectal/core methods	Often closer to core temperature in selected settings.	Invasive; avoid when contraindicated and follow local policy, infection-control and consent requirements.

Always document the site and method. A temperature without a site is incomplete because oral, axillary, tympanic and core measurements are not interchangeable.

24. Procedure for digital temperature measurement

Explain the procedure, provide privacy and select the approved site for the patient’s condition.
Perform hand hygiene and apply a disposable probe cover if required.
Position the probe correctly and maintain contact until the device signals completion.
Read the value, confirm the unit (°C or °F) and remove/discard the cover safely.
Clean the device according to the manufacturer and infection-control policy.
Repeat an unexpected value with a suitable method and check the patient for clinical signs of heat or cold illness.
Record time, site, method, value, associated symptoms and interventions.

25. Fever and hyperthermia

Pattern	Possible causes	Focused emergency assessment
Fever with infection symptoms	Respiratory, urinary, skin, gastrointestinal or other infection.	Source, duration, mental status, perfusion, urine, breathing, pregnancy and immunosuppression.
High temperature after heat exposure	Heat exhaustion or heat stroke.	Environment, exertion, mental status, skin, hydration and rapid cooling/transport protocol.
Fever with rash or stiff neck	Potential serious infection or inflammation.	Consciousness, seizures, photophobia, perfusion, exposure and isolation precautions.
High temperature after medicine/substance	Drug toxicity, serotonin syndrome, anticholinergic effects or withdrawal.	Substance, timing, agitation, rigidity, pupils, sweating, pulse and BP.

Fever is a sign, not a diagnosis. The degree of temperature, rate of rise, patient age, appearance and associated findings all affect urgency.

26. Hypothermia

Hypothermia may result from cold exposure, wet clothing, immersion, shock, endocrine disease, intoxication, low glucose or impaired mobility. Shivering can stop as the patient becomes more severely cold; absence of shivering is not reassuring.

Remove the patient from the cold environment and wet clothing when safe; protect dignity.
Handle gently because a cold myocardium may be irritable.
Assess airway, breathing, circulation, mental status and glucose; check for trauma and coexisting illness.
Use appropriate insulation and active warming methods within local protocol.
Repeat temperature with a suitable low-range device if the initial thermometer is unreliable.
Arrange urgent transport for altered consciousness, severe hypothermia, arrhythmia, trauma or inability to rewarm.

27. Factors that alter temperature readings

Factor	Effect or issue
Time of day	Temperature usually varies over the day; compare readings at similar times when monitoring trends.
Exercise or exertion	Increases heat production and may raise temperature transiently.
Ambient heat or cold	Changes peripheral measurements and can cause genuine heat or cold illness.
Recent food/drink	Can distort oral temperature.
Oxygen therapy or mouth breathing	May make oral readings less reliable.
Sweating or wet skin	Can interfere with temporal or surface methods.
Age and frailty	Older adults and infants may have serious infection without a large fever.
Medication	Antipyretics, steroids, sedatives and other medicines may blunt or alter temperature response.

28. Integrating BP, pulse and temperature

BP	Pulse	Temperature	Possible pattern	Priority
Falling	Fast/weak	Normal or low	Haemorrhage, dehydration or advanced shock.	Find/control cause, support perfusion, urgent escalation.
Low/normal	Fast	High	Sepsis, heat illness or dehydration.	Look for infection/heat source, mental-status change and poor perfusion.
High	Fast	High	Pain, stimulant, severe stress or hyperthermic syndrome.	Assess neurological, cardiac and toxicological red flags.
High	Slow	Normal/low	Possible raised intracranial pressure, medication effect or conduction problem.	Repeat, assess consciousness, pupils and breathing; urgent support.
Normal	Slow/irregular	Low	Hypothermia, medication effect or dysrhythmia.	Warm and monitor according to protocol; assess airway and perfusion.
Normal initially	Normal initially	Normal initially	Early illness or masked response.	Use history, appearance and serial observations; do not falsely reassure.

These patterns are prompts for assessment, not diagnoses. The same combination can occur in several conditions, and a patient may have more than one problem.

29. Reassessment intervals and escalation

Reassessment frequency depends on acuity, treatment, transport time and local protocol. Unstable patients require continuous observation and repeated vital signs; stable patients still need repeat measurements when symptoms change, after intervention and before handover.

Repeat immediately if the value is impossible, inconsistent with the patient, or associated with deterioration.
Repeat after bleeding control, fluid/medication intervention, oxygen, warming, cooling, bronchodilator treatment, analgesia or a change in position.
Trend values on the same limb/site and with the same method where possible.
Compare with previous readings and the patient’s baseline rather than relying only on population ranges.
Escalate a new abnormal value with symptoms, a rapidly changing trend, poor perfusion, altered consciousness or severe pain.

30. Documentation of vital signs

Record	Example
Time and patient position	“14:20, seated after 5 minutes rest” or “supine during trauma assessment.”
Blood pressure	“BP 118/74 mmHg, right upper arm, adult cuff, automated.”
Pulse	“Radial pulse 104/min, regular, weak, equal bilaterally.”
Temperature	“T 38.4°C tympanic, probe cover used.”
Factors and treatment	“Patient febrile after paracetamol at 13:55; reading repeated because first cuff was too small.”
Response and escalation	“BP fell to 88 systolic with dizziness; supervisor and receiving facility notified; urgent transport.”

Do not write only “vitals stable.” List the actual values, units, time and method. A trend is meaningful only when each measurement can be understood and compared.

31. Quality assurance and troubleshooting

Compare an automated BP with a manual reading when the patient is symptomatic or the rhythm is irregular.
Check batteries, cuff tubing, valve, probe covers, calibration labels and device error messages.
Warm a cold finger before using a peripheral pulse or pulse-oximeter reading; poor perfusion can produce unreliable data.
Count the pulse for a full minute when irregular rather than multiplying a short count.
Repeat a temperature when the reading conflicts with the patient’s appearance or the site was compromised.
Use a different arm or approved site when injury, infusion, fistula or surgery affects the usual site.
Document limitations such as patient movement, crying, seizure, shock, pain or inability to cooperate.

32. Worked emergency scenarios

Scenario 1: Possible haemorrhagic shock after a crash

A patient is pale, anxious and thirsty. The first BP is 104/72 mmHg and the radial pulse is 122/min and weak. The EMT does not call the BP normal and stop. The team searches for external and hidden bleeding, assesses mental status and skin, repeats observations, controls haemorrhage, requests additional support and transports urgently. The pulse and trend provide an early warning before profound hypotension.

Scenario 2: Fever with deterioration

A young adult has temperature 39.2°C, pulse 128/min and increasing confusion. The EMT asks about infection, duration, medicines and fluid intake, assesses perfusion, breathing, skin and mental status, repeats BP, identifies possible sepsis and escalates according to local protocol. Antipyretic treatment alone would not address the underlying emergency.

Scenario 3: Severe hypertension with neurological symptoms

A patient’s BP is 198/122 mmHg with severe headache, vomiting and new weakness. The EMT confirms cuff size and repeats the reading without delaying care, checks consciousness, pupils, speech, glucose and limb strength, asks about onset and medicines, and arranges urgent transfer. The symptoms, not the number alone, define the emergency.

Scenario 4: Unreliable automated reading

An automated monitor displays repeated errors in a patient with cold, clammy skin and a weak pulse. The EMT checks cuff position, warms and supports the arm, palpates central and peripheral pulses, obtains a manual pressure if trained and calls for advanced help. “No reading” is treated as a problem to solve, not evidence that the patient is stable.

Scenario 5: Hypothermia after rain exposure

A patient is confused, shivering weakly and cold to touch. The EMT removes wet clothing, insulates the patient, measures temperature with a suitable method, checks glucose and trauma, handles gently, repeats observations and arranges urgent transport. Stopping shivering would not be interpreted as recovery without a complete reassessment.

Scenario 6: Irregular pulse and syncope

A patient reports palpitations and fainting. The radial pulse is irregularly irregular at 136/min. The EMT counts for a full minute, compares apical and radial rates if possible, measures BP and temperature, asks about cardiac disease, medicines and anticoagulants, monitors continuously and escalates for possible dysrhythmia.

33. Common errors to avoid

Using a cuff over clothing or choosing a size by appearance rather than arm circumference.
Measuring BP while the patient is talking, moving, unsupported or holding the arm below heart level.
Repeating a high or low result without correcting the technique that caused the error.
Taking a short pulse count in an irregular rhythm and reporting a falsely precise rate.
Using the thumb to palpate a pulse.
Palpating both carotids together or pressing too hard.
Recording temperature without the site, method or unit.
Assuming no fever means no serious infection.
Calling hypotension or hypertension without considering symptoms, baseline and perfusion.
Ignoring a falling trend because each individual value remains inside a reference range.
Writing “stable” instead of actual values and time-stamped reassessments.
Failing to report an abnormal reading to the next clinician during handover.

34. EMT vital-sign checklist

Is the scene safe and is the patient’s immediate primary survey complete?
Have I explained the procedure, protected privacy and positioned the patient safely?
Is the equipment clean, functional, correctly sized and appropriate for this patient?
For BP: is the patient rested where possible, cuff on bare skin and arm supported at heart level?
For pulse: have I counted long enough and assessed rhythm, strength and equality?
For temperature: have I selected a suitable site and recorded the method and unit?
Do the numbers agree with the patient’s appearance, history and perfusion?
Have I repeated unexpected values and checked for equipment or technique errors?
What treatment or change occurred before the next reading?
Have I documented time, position, site, method, values, trend and limitations?
Have I escalated abnormal or rapidly changing observations?
Can I communicate the current values and trend during handover?

35. Revision questions

Define vital signs and list the traditional four.
Why should vital signs be interpreted as trends rather than isolated numbers?
Define systolic and diastolic blood pressure.
Calculate pulse pressure for a BP of 140/90 mmHg.
What is the approximate MAP formula?
List six preparation steps for accurate BP measurement.
How does an incorrectly small cuff affect BP?
Describe manual BP measurement from positioning to documentation.
What are Korotkoff sounds and how are they used?
When should an automated reading be repeated or confirmed manually?
List five possible causes of hypotension in an emergency patient.
What findings suggest shock even before severe hypotension?
Define pulse rate, rhythm, strength and equality.
Name six pulse sites and one use for each.
Why must the thumb not be used to count a radial pulse?
When should the pulse be counted for a full 60 seconds?
What is a pulse deficit?
List causes of tachycardia and bradycardia.
Define fever, hyperthermia and hypothermia.
Compare oral, axillary, tympanic and temporal temperature methods.
Why must temperature site and method be documented?
Describe the emergency assessment of a patient with suspected heat illness.
Describe the first priorities for a hypothermic patient.
Interpret BP 104/72 with pulse 122 and pale clammy skin after trauma.
Write a complete vital-sign entry for a patient with an irregular pulse.

36. Key take-home messages

Accurate technique is part of patient safety; poor technique creates false clinical decisions.
Blood pressure describes pressure, pulse describes cardiac/peripheral activity and temperature describes thermal balance.
Rate, rhythm, strength, equality, site, position, method, time and trend all matter.
A patient may be in danger before a single number crosses a reference threshold.
Repeat abnormal readings, correct technique and investigate the patient’s condition.
Always communicate abnormal values and trends during handover and escalation.

References and further reading

Study note: These notes support supervised emergency-medical training. Use current Uganda Ministry of Health, ambulance-service, facility and medical-direction protocols for thresholds, equipment, treatment, transport and escalation.