The Importance of Taking Patient Vital Signs at Initial Presentation: A Case-Based Review

By Lauren Campion, CVT

Obtaining vitals on all patients, regardless of their presenting complaint, is paramount to facilitating the best possible outcome for all of our veterinary patients. It is an essential starting point for monitoring the dynamics of a patient’s status from presentation to discharge. Moreover, obtaining vital signs accurately is an underrated skill that all veterinary nurses should be able to perform both efficiently and accurately.

Vital signs that should be focused on during the patient’s initial rapid assessment should include temperature, heart rate, mucous membrane color, capillary refill time (CRT), and respiratory rate at a minimum. The sum of these parameters should serve as a guide for the veterinary team on how to proceed. Review the case presentation below and consider how you and your team would respond.

Case Presentation and Initial Assessment

Albus, a 7-year-old castrated male domestic short hair feline, presents to the clinic with a client complaint of being lethargic, not eating breakfast normally, and one episode of vomiting. He is indoor only. Historically, he is a diabetic on insulin.

He presents laterally recumbent in his carrier and is immediately taken into the treatment area for rapid assessment. Vital signs are obtained and reveal that he is hypothermic at 97 degrees and bradycardic at 120 beats per minute. His mucous membrane color is a pale pink, they feel tacky, and his CRT is slightly prolonged at 2.5 seconds. Albus’s respiration is counted at 10 respirations per minute. Mentally, he appears dull but is looking around.

How do you respond as a technical team?

Patient Stabilization

The vital signs obtained show severe abnormalities, including bradycardia, hypothermia, and decreased respiratory rate. The veterinary team should be working together to stabilize this patient rapidly. Ideally, someone should be working on obtaining IV access and obtaining a blood sample to check a blood glucose level. Meanwhile, a second team member should be documenting the timeline of the vitals and responding to them appropriately:

• hypothermia should prompt the team to start heat support.

• bradycardia and decreased respiration should prompt the placement of monitoring equipment, such as an ECG and pulse oximetry.

• flow-by oxygen can be provided.

While your monitoring equipment is running, a team member should constantly reassess the patient’s status and vital signs as if you were running anesthesia. Every 5 mins you should be manually re-measuring your primary vital signs and responding accordingly.

Case Progression

A team member is able to obtain IV access with a peripheral catheter and obtain a blood sample. The blood sample was used to obtain an initial blood glucose level of 40 mg/dL on a glucometer reading, showing that Albus is hypoglycemic.

Under the direction of a veterinarian, the team works together to give an appropriate dextrose bolus IV and institute a dextrose CRI. Simultaneously, the technician reassessing vital signs communicates any and all parameter changes that are happening. For example, while on heat support, is the temperature rising or continuing to fall? These changes should be noted on a timeline and the actions taking to respond to them should be recorded as well.

Albus’ body temperature steadily rises and heat support is discontinued once he becomes normothermic. Over time, the ECG shows a heart rate of 180 beats per minute, which is confirmed through auscultation. The respiratory rate increases to 32 breaths per minute. Within an hour of arriving, the patient is sitting sternal and appears to be more alert and mentally appropriate.

The Role of the Veterinary Team

Originally, these abnormal vital signs were most likely secondary to the patient’s hypoglycemic episode. Although it was essential to address the hypoglycemic crisis, the patient’s recovery would have been prolonged if the vital signs were not obtained and responded to simultaneously. Having a strong veterinary team that recognizes the importance of vital signs, responds to abnormalities quickly, and maintains good communication is essential to successfully stabilizing a patient.

Test Your Knowledge (See answers on page 32)

1. What is a cat’s normal heart rate when presenting to the veterinary clinic?

a. 160 -180 beats per minute b. 120 -150 beats per minute c. 220 -250 beats per minute d. 80 -120 beats per minute a. Between 99 and 102.5 degrees Fahrenheit b. Between 89 and 101.5 degrees Fahrenheit c. Between 75 and 100.2 degrees Fahrenheit d. Between 101 and 104 degrees Fahrenheit a. 5 -15 breaths per minute b. 20 -25 breaths per minute c. 30 -45 breaths per minute d. 20 -30 breaths per minute a. 1-2 mL/kg; diluted 1:2-1:4 in a sterile fluid and administered slowly as bolus (usually over 5 minutes). b. 2-4 mL/kg; diluted 1:2-1:4 in a sterile fluid and administered slowly as bolus (usually over 5 minutes). c. 0.5 -1 mL/kg; diluted 1:2-1:4 in a sterile fluid and administered slowly as bolus (usually over 5 minutes). d. 0.1-0.2 mL/kg; diluted 1:2-1:4 in a sterile fluid and administered slowly as bolus (usually over 5 minutes). a. 25 ml b. 50 ml c. 100 ml d. 5 ml

2. What is a cat’s normal temperature when presenting to the veterinary clinic?

3. What is a cat’s normal respiratory range?

4. What is the standard 50% dextrose dose to give as a bolus to stabilize a cat undergoing a hypoglycemic crisis?

5. Calculate how much 50% dextrose would you place into a 500 ml bag of LRS to make a 2.5% solution.

References for quiz: https://www.hillspet.ca/en-ca/cat-care/healthcare/normal-cattemperature-and-checking-vital-signs https://app.plumbs.com/drug-monograph/q9r5NvdiFsPROD?source=se arch&searchQuery=dextrose

Koenig A. Hypoglycemia. In: Silverstein D, Hopper K, eds. Small Animal Critical Care Medicine. St. Lous: Elsevier Saunders; 2008:295-297.

About the Author: Lauren Campion currently works at a small animal emergency hospital in Delaware County, Pennsylvania. She has a strong passion for veterinary emergency medicine and has been working in the field for the past 10 years. Lauren obtained her CVT in 2019 through the Penn Foster programs. She also has a BA in Biology from Widener University.