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When should you worry about vital signs?


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This week’s recommendation is a podcast by the wonderful SGEM.

It’s Ken Milne interviewing Dr Anthony Crocco about identifying when vital signs are abnormal.

They discuss a systematic review looking at the normal values of HR and RR in children. The results are compared with the PALS and APLS guidelines (which most of us use) to identify where we are falling short.

If you only listen to one podcast this week. Make it this one.

Listen to the podcast.

Read the show notes.

About the authors

  • Tessa Davis is a Consultant in Paediatric Emergency Medicine at the Royal London Hospital and a Senior Lecturer at Queen Mary University of London.


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3 thoughts on “When should you worry about vital signs?”

  1. Marlais M, Lyttle MD, Inwald D, Ten concerns about blood pressure measurement and targets in paediatric sepsis. Intensive Care Med. 2017 Mar;43(3):433-435.

    3. Oscillometric BP monitors do not use a standard methodology and most have not been validated in children

    Where validation data is available for oscillometric devices, this has generally been in the context of hypertension rather than hypotension.

    4. The most commonly quoted BP ranges in children are from the US National Institutes of Health (NIH) Task Force, derived
    from auscultatory data

    5. Hypotension, defined as <5th centile SBP for age, has been derived using mathematical modelling rather than by direct observation

    6. Very few observational studies have reported lower centile BP data

    7. The original consensus conference definition of hypotension in septic shock was retracted

    8. Advanced paediatric life support and paediatric advanced life support have differing definitions of hypotension

    9. There are no agreed BP targets for sepsis resuscitation in children

    10. Trial evidence for therapy does not exist in children

  2. Great podcast! Based on this, do you think the “normal vital signs” table in the DTFB quick reference section should be changed to the Fleming charts?

    1. Thanks Penny – you make a good point. I’ll add it to our DFTB to-do list to take a look at this and will add the Fleming charts to the quick reference page too.



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