THIS IS A GIMMICK.
Before reading this post, please understand my motives.
Regurgitation fails to provide optimal patient care.
Obviously, it is important to know normal vital sign ranges cold. They should be easily accessible in our brains so that when we are assessing a patient, the normals come easily for comparison.
These vital sign ranges are daunting for EMT students. And judging from the number of vital signs charts I see taped to the walls of ambulances … and on clipboards … and on name tags, a lot of us still have trouble remembering them.
This chart is found in the AAOS Orange book. Every textbook is different. The technique of building it that I describe here is what I used to regurgitate the information for Registry. It is a crutch. This is NOT how it should be entered in anyone's brain. But it worked for me. I wrote this out at the beginning of the Registry exam and was able to refer back to it. I am sharing this so that students in the grammar stage can have SOMETHING to start the process of learning normal values. That's all. Do you hear me? Gimmick. Crutch.1) Start by forming your grid. Obviously, on Registry you will not have graph paper, but you will have paper and a pencil (or in my case, I had a white board and a dry erase marker). Draw an 18 x 27 rectangle. Divide it with vertical lines spaced at 9, 4, 4, 4, 6 boxes. Draw horizontal lines so they are 2 boxes apart.
2) Label the top of the grid with APRS-T. For amateur radio operators like me (73s), this is Automatic Packet Reporting System Tracker. If you aren't a ham, then, well, maybe you should look into that. On this chart, APRS-T will be: Age, Pulse, Resp, Systolic, and Temp. For the left side of the grid, use NIT/PSA/EML. Kids get lice--nits. Gross, hey, but memorable. Neonate, Infant, Toddler. When there is an outbreak, they will put out a PSA, a public service announcement. Preschool, School age, Adolescent. And they will show it allll day. Early, Middle, and Late.
Most classes will pound certain ranges and values into your brain. I won't be covering those here. One of those ranges is that Neonates are 0 - 1 month. And because we like to keep things easy, let's stick with 1s and say that infants are 1 month - 1 year. Toddlers are so cute. When you ask them how old they are, they say "Fwee!" Toddlers are 1 year - Fwee.
Then we get to a major concept of this chart. We love the number 6. LOVE IT. Got it? 6. Gotta start those preschoolers out right, so they will love 6, too. Preschoolers are 3-6.
Love 6. Now we move in multiples of 6. School age are 6 - 12. Adolescent are 12 - 18. Multiples of 6.
Early adult then would start at 19 and go until they're over the hill: 40. Middle adults go from over the hill (41) to senior age. AAOS defines that here as 60 but other sources will place it at 65.
Age ranges:
Neonate: 0 - 1 month
Infant: 1 month - 1 year (keep it easy with 1s)
Toddler: 1 year to Fwee
Preschool: Fwee to 6 (love 6)
School Age: 6 - 12 (multiples of 6)
Adolescent: 12 - 18 (multiple of 6)
Early Adult: 19 - 40 (over the hill)
Middle Adult: 41 - 60 (over the hill to senior age)
Late Adult: 60 and up
3) Time to start filling things in. We love 6s, and we know there are certain normals everyone knows. Over in the temperature column, place 98.6 <---see the 6? in the grid 6 times. I color them red (red/temperature/heat).
For the box above that, use the same numbers, just mix them up: 96.8 (and mark it with a squiggly). Now this box is a range, so the next number in it will be higher than the 98—make it 99—but we like 6, remember? 99.6. You worked hard for that, so repeat it in the box above that one. Color them orange.
I like sweet, round, squishy babies. They should have round, squishy numbers. The top neonate box is 98 - 100 <---see the round numbers? Use another warm color. I chose yellow—sometimes parents don't know the sex of their baby and get all the nursery accouterments in yellow.
4) Geriatrics patients can make your eyes cross. They can have so many co-morbid conditions, who knows what's really going on or what their normal is? We're going to make this easy: mark all of the older adult vitals as 'varies.'
5) Do some more easy things. Enter the baselines that every class knows:
Pulse: 60 - 100
Resp: 12 - 20.
These you must know cold. Memorize. Color them green because they are automatic.
Another category to know off the top of your head is infant respiratory norms. Infants like to put everything in their mouths, but that can be bad because those things can get stuck in their windpipes. Things like quarters. Quarters are 25 cents.
Infant Resp Rate (at the windpipe): 25 - 50
I put a circle between the two boxes to remind me of quarters
6) Neonates and infants are complicated, but we can look for patterns here. 25 - 50 was the range of infant respirations. 25 x 2 = 50.
We did it once, so let's do it again. But first, STEP BY 10 up a space from the 50—make it a 60. 30 x 2 = 60. Mark the STEP BY 10 with a bridge.
Infant Respirations: 25 - 50
Neonate Respirations: 30 - 60 <---STEP BY 10
1st number x 2 = 2nd number
I still like squishy, round babies, especially when it comes to their pulses. The 100 at the top of the adult pulse range has lots of roundness. And 8 is round, too.
Neonate Pulse: 100 - 180 <---very round and squishy
Babies are sorta purple when they are born, so I color those boxes purple.
7) So round and squishy, let's do it again. And we love six, so add that in, too. Round, squishy, and six. Can't beat it.
Infant pulse rate: 100 - 160
A big part of early childhood is learning to walk. STEP BY 10 alllll that way to adulthood.
I mean, it's a BIG part of childhood, so do it in the next column, too.
BUT they eventually figure it out, so stop at preschool and jump by 20 (school age children LOVE jumping).
8) Whew! That's a lot. Take a break, and let's talk triage.
In Jump Start Triage, a provider assesses a child's respiratory rate. If the child is breathing but it is not between 15 and 45, then the child is given a red tag. 15 and 45 are easy numbers to remember if you think of a clock. And if you color the area outside of 15 and 45 red, it looks like a Pokemon ball.
But for a non-MCI, a child's normal respiratory rate is 15 - 30. Cut the Pokemon ball in half.
Add that 15 - 30 to the children's area of the chart.
9) If you look at the neonate/infant resp area of the chart, you can see there was already another 30 there. It had a 25 below it, so add a 25 below the new 30, too. Color these grey.
At this point, numbers are dripping out of my ear. I just want to be finished. 20 was used in the adult respiratory area, so just fill in all the other boxes with 20s. Color them green, too, to be consistent.
10) Children often get jealous of others. I've talked about round and squishy babies, and they want to be round and squishy, too. So all of the children systolic ranges are going to start with 80 <--nice and round. Color them blue like a river. Rivers need bridges, so STEP BY 10 (mark with a bridge) to 70 above and 90 below. Adolescents are pretty much adults, so write 90 all the way down.
11) I mentioned before how sometimes parents don't know the sex of their baby and choose to decorate with yellow. Sometimes, though, parents do know the sex, so they can choose to decorate with pink and blue. They could even use bows at jaunty angles.
12) Toddlers like to yell, "Mine!" Especially when the new baby has something they want. So, add those nice purply 100s to the toddlers. We hope that older children grow out of that stage and learn to share. STEP BY 10 out of that and give school age and adolescents 110.
Adults are more concerned about being over the hill. So, put their systolics at 140.
That leaves a blank space, and I'm running out of ideas. It's a 95. Kinda hard to remember, so I put an exploding star around the number. That represents my brain at this point. One way to remember is that 25 + 70 = 95. I underline those numbers.
And there ya go. The entire chart is filled in. Finally.
