Think of vital signs as the body’s most basic news report. Before a patient says a word about their headache, before we see an X-ray, or before we get blood test results, the vital signs are talking. They are the first and most constant data we collect. Every time. For every patient. In an ambulance, a clinic, a hospital room, or a home visit, these numbers form a universal language that all medical professionals understand.

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For doctors, nurses, paramedics, and medical assistants, checking vitals is not just a routine task. It is the cornerstone of clinical assessment. They tell us if a body is in balance or if it is fighting a silent battle. A small change in a vital sign can be the first clue to a big problem. It can also show us if our treatment is working. This blog will explain the “why” and “how” behind these critical measurements. We will look at each of the six main vital signs, understand what they mean, and see how to use them in our daily notes and clinical thinking.

The Core Four (Plus Two)

For many years, vital signs meant four things: temperature, pulse, respiration, and blood pressure. We often call them the “core four.” In modern practice, we officially add two more: oxygen saturation and pain level. This makes a complete set of six. Let’s break each one down.

1. Body Temperature: The Internal Thermostat

Body temperature is a measure of how much heat the body is making and losing. The body is amazing at keeping its temperature within a very narrow, safe range. This process is called thermoregulation. When temperature goes outside this range, it is a clear sign that something is wrong.

We measure temperature in degrees Fahrenheit (°F) or Celsius (°C). The normal range for a healthy adult is about 97.8°F to 99.1°F (36.5°C to 37.3°C). It can change a little based on the time of day, activity, or for women, their menstrual cycle. We can measure it in different places: the mouth (oral), ear (tympanic), forehead (temporal), armpit (axillary), or rectum (rectal). Rectal temperatures are the most accurate for core body temperature, especially in infants.

A temperature above 100.4°F (38°C) is generally a fever. This is usually a sign that the body is fighting an infection, like the flu or a bacterial illness. A very high fever (over 103°F or 39.4°C) needs urgent attention. On the other end, a temperature below 95°F (35°C) is hypothermia. This can happen from being in the cold too long, but also in sepsis, shock, or in older, frail patients. It is a serious condition that can slow down all the body’s vital functions.

2. Pulse (Heart Rate): The Rhythm of Life

The pulse is the wave of blood that flows through our arteries with each heartbeat. Feeling a pulse tells us two main things: how fast the heart is beating (heart rate) and how strong and regular the rhythm is.

We measure heart rate in beats per minute (bpm). The normal resting rate for an adult is 60 to 100 bpm. A well-trained athlete might normally have a rate in the 40s or 50s. We commonly check the pulse at the radial artery in the wrist or the carotid artery in the neck. When we check it, we note:

• Rate: The number of beats per minute.
• Rhythm: Is it regular? Or is it irregular, skipping beats or having extra beats?
• Strength: Is it strong and bounding? Or is it weak and thready?

A heart rate over 100 bpm at rest is called tachycardia. This can happen with fever, anxiety, pain, blood loss, heart problems, or simply with exercise. A heart rate below 60 bpm is called bradycardia. This can be normal in fit people, but it can also be a sign of heart block, hypothyroidism, or the effect of certain medications. An irregular pulse, like in atrial fibrillation, is a critical finding that needs further checking, often with an EKG.

3. Respirations: The Breath of Assessment

Respiration is the act of breathing. It involves bringing oxygen into the lungs and removing carbon dioxide. When we count respirations, we are not just counting. We are watching a complex process.

The normal rate for an adult is 12 to 20 breaths per minute. Children breathe faster. We count breaths by watching the rise and fall of the chest for a full minute, often right after taking the pulse so the patient doesn’t know and doesn’t change their natural breathing. We look at:

• Rate: Breaths per minute.
• Rhythm: Is it regular?
• Effort: Is breathing easy and quiet? Or is it labored? Are they using neck or abdominal muscles to breathe (accessory muscle use)? Do you hear wheezing, gurgling, or stridor?
• Depth: Are breaths shallow or deep?

A rate over 20 (tachypnea) can signal pain, fever, anxiety, lung problems like pneumonia, or a condition like diabetic ketoacidosis. A rate below 12 (bradypnea) can be caused by head injury, opioid overdose, or severe illness. Noting “labored breathing” or “audible wheezes” is as important as the number itself.

4. Blood Pressure: The Force of the System

Blood pressure (BP) is the pressure of blood pushing against the walls of the arteries. It is the force that keeps blood flowing to your brain, heart, and kidneys. It is written as two numbers: systolic over diastolic (e.g., 120/80 mmHg).

• Systolic Pressure (Top Number): The pressure when the heart beats and pumps blood out.
• Diastolic Pressure (Bottom Number): The pressure when the heart rests between beats.

Normal blood pressure for an adult is less than 120/80 mmHg. Hypertension (high blood pressure) is a systolic pressure of 130 or higher, or a diastolic of 80 or higher, on multiple readings. This is a major risk factor for heart attack, stroke, and kidney disease. Hypotension (low blood pressure) is typically a systolic below 90 mmHg. This can cause dizziness, fainting, and can be a dangerous sign of shock, dehydration, or severe infection. A single high reading does not mean a patient has hypertension, but it is a vital clue that must be tracked.

The Modern Additions

5. Oxygen Saturation: The Red Light of Oxygen

Pulse oximetry is a simple, non-invasive way to measure the percentage of hemoglobin in the blood that is carrying oxygen. We write it as SpO2. A small clip-like device (a pulse oximeter) is placed on a finger, toe, or earlobe.

A normal SpO2 for a healthy person at sea level is 95% to 100%. Values between 91% and 94% may indicate mild hypoxemia (low oxygen in the blood). An SpO2 of 90% or below is a medical emergency and usually requires supplemental oxygen. It is crucial for patients with COPD, pneumonia, heart failure, asthma, or COVID-19. Remember, the oximeter also shows a pulse rate, which is a good double-check. Poor circulation, nail polish, or dark skin pigmentation can sometimes affect the accuracy of the reading, so clinical judgment is always key.

6. Pain: The Fifth Vital Sign

Pain is whatever the experiencing person says it is. It is subjective, but it is very real. Treating pain is a core part of ethical medical care. We must assess pain at every encounter.

We often use a scale of 0 to 10, where 0 is no pain and 10 is the worst pain imaginable. For children or those who cannot speak, we use face scales (smiley to crying faces). We also ask to describe the pain: Is it sharp, dull, aching, burning? Where is it located? Does it move? What makes it better or worse? Documenting pain and then reassessing after an intervention (like giving medication) is critical. For example, “Patient reports abdominal pain 8/10, sharp and constant. After 1 dose of morphine, pain decreased to 3/10.”

Vital Signs Template

Having a standard way to document vital signs prevents errors and makes information easy to find for every member of the care team. Here is a clean, professional template you can use in any setting:

VITAL SIGNS

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Date/Time: [e.g., 10/26/2026 14:30]
T: [°F or °C] (Route: Oral/Tympanic/Temporal/Rectal/Axillary)
P: [##] bpm (Site: Radial/Carotid/Apical) (Rhythm: Regular/Irregular)
R: [##] /min (Effort: Unlabored/Labored, Accessory muscle use noted)
BP: [###/##] mmHg (Position: Sitting/Supine/Standing) (Arm: Left/Right)
SpO2: [##]% (Room Air / on [##] L O2 via nasal cannula)
Pain: [0-10] (Scale: Numeric/Faces) (Location/Description: [e.g., “sharp, lower back”])
Notes: [Any relevant context, e.g., “Patient anxious,” “Reading after walking from waiting room,” “Unable to obtain radial pulse, carotid weak and thready.”]

Vital Signs in SOAP Note

The SOAP note (Subjective, Objective, Assessment, Plan) is the standard way to organize a patient visit. Vital signs are a key part of the Objective (O) section. They are measurable, observable data. Let’s see how they fit into a full clinical picture with two examples.

Example 1: Urgent Care Visit for “Cough and Fever”

• S: “I’ve had a bad cough with green mucus for three days. I feel hot and achy, and I’m so tired I can’t get off the couch.”
• O:
  • Vitals: T: 102.1°F (Oral), P: 110 bpm (Radial, Regular), R: 22/min (Labored, occasional cough), BP: 118/76 mmHg (Sitting, Left), SpO2: 94% (Room Air), Pain: 4/10 (Achy muscles, headache).
  • Exam: Lungs: crackles and wheezes in right lower lobe. Throat: mildly red.
• A: 1. Acute bronchitis with suspected secondary bacterial infection. 2. Febrile illness.
• P: 1. Prescribe course of antibiotics. 2. Recommend antipyretics for fever >101°F. 3. Advise increased fluid intake. 4. Return if shortness of breath worsens or SpO2 drops below 92%.
• How the vitals helped: The fever (102.1°F) and fast heart rate (tachycardia) confirm the febrile, systemic illness. The rapid respiratory rate (tachypnea) and slightly low SpO2 point to the lungs being involved, guiding the exam focus. The elevated pulse also fits with the body’s increased metabolic demand from fighting infection.*

Example 2: Post-Op Check on Surgical Floor

• S: “My incision hurts, but the medicine helps. I feel a little dizzy when I try to stand up to go to the bathroom.”
• O:
  • Vitals (Lying): T: 98.6°F (Temporal), P: 85 bpm (Radial, Reg), R: 16/min (Unlabored), BP: 110/70 mmHg (Supine), SpO2: 98% (Room Air), Pain: 2/10 (Incision site, dull).
  • Vitals (Standing – 2 min later): T: — , P: 120 bpm (Radial, Reg), R: 18/min, BP: 88/60 mmHg (Standing), SpO2: 98%, Pain: 3/10.
  • Exam: Incision clean, dry, intact. Skin tenting noted.
• A: 1. Orthostatic hypotension likely due to dehydration and post-op status. 2. Well-controlled post-operative pain.
• P: 1. Increase IV fluids as per protocol. 2. Encourage oral fluids as tolerated. 3. Instruct to sit on edge of bed for 1 minute before standing, and call for assistance with first ambulation. 4. Continue scheduled pain medication.
• How the vitals helped: The orthostatic vitals (big jump in heart rate and drop in BP upon standing) provided objective proof of the patient’s subjective “dizziness.” This pinpointed the problem as volume-related (dehydration) rather than just pain or weakness, directly guiding the treatment plan (IV fluids and safety instructions).*

The Bottom Line

Vital signs are the foundation of patient safety and clinical judgment. They are a quick, powerful look inside the body. They guide our questions, focus our physical exam, and tell us if a patient is stable or crashing. They are dynamic – a single set is a snapshot, but trends over time tell the real story. Is the fever coming down with antibiotics? Is the heart rate slowing as the patient becomes less dehydrated? Is the oxygen saturation improving with therapy?

As medical professionals, we must never fall into the trap of collecting these numbers on autopilot. See them, think about them, and connect them to the patient’s story. That 9th-grade reading level understanding—that temperature is heat, pulse is the heartbeat, and blood pressure is the push of blood—is the exact same core knowledge that, when applied with skill and judgment, saves lives every single day. Master them, respect them, and let them guide your care.

References

• Pickering, T. G., et al. (2005). Recommendations for Blood Pressure Measurement in Humans and Experimental Animals. Hypertension, *45*(1), 142-161.
  https://www.ahajournals.org/doi/full/10.1161/01.HYP.0000150859.47929.8e
• American Heart Association (AHA). (2020). Understanding Blood Pressure Readings. The AHA sets the clinical standard for blood pressure classification, measurement technique, and management guidelines in the United States. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings
• World Health Organization (WHO). (2020). Clinical Management of COVID-19: Living Guideline. This WHO document formally establishes pulse oximetry (SpO2) as a critical vital sign for patient assessment and management in acute illness. https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-2
• Johns Hopkins Medicine. (n.d.). Vital Signs. Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure) https://www.hopkinsmedicine.org/health/conditions-and-diseases/vital-signs-body-temperature-pulse-rate-respiration-rate-blood-pressure

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