 Let's talk about vital signs. So the rule of thumb here is you need to be updating the vital signs for patients, especially blood pressure every two years. But if somebody has higher blood pressure or even lower blood pressure or it's being monitored, then it's best to do it at least once a year. So I'm going to go over the different vital signs. So blood pressure, pulse, respiration, what's normal and what is not normal. So let's just flip through here. So blood pressure, the main things that you need to know is that this is the force that is exerted by blood on the walls of the blood vessels during contraction and relaxation of the heart. So it's basically the force that's pushing the blood out. If there's not a lot of force, that's not a good thing. If there's too much, that's not a good thing either. Another thing to keep in mind is blood pressure can increase if somebody's been exercising. If somebody's been running outside, it's a super hot day, then the blood pressure can increase. Does that mean, oh no, they have to go to the hospital, it's too high? No, but it needs to be monitored. So for example, if you have a patient who's been running to their appointment because they were late for their teeth cleaning and then you go to take their blood pressure and it's unusually high for them, ask them questions, kind of go, oh, your blood pressure is higher today. Is there a reason for that? Have you been exercising? And then they would likely tell you, well, I just ran to my appointment for the past 20 minutes. So that makes sense. Then it might be best to take the blood pressure at the end of the appointment just to double check. What I normally do is even if the blood pressure is high or low at the beginning of the appointment, I'm going to take it again at the end of the appointment because patients are likely nervous or I don't know about you, but I'm like this too, where if somebody's taking my blood pressure, for some reason it just makes me, maybe nervous isn't the right word, but it's going to be a little bit higher than normal. So take it at the end again, just to make sure that the reading is correct. So then two things you need to keep in mind. And I have highlighted them here at the bottom for you. So systolic pressure, this is the force that is exerted during ventricle contraction, the highest pressure in the cardiac cycle that's going to be the top number. The bottom number of blood pressure is the diastolic pressure. This is the resting pressure, which occurs during ventricle relaxation. This is something you need to know, the lowest pressure of the cardiac cycle. So you need to know the differences between systolic and diastolic. So systolic again, basically it's the highest pressure. It happens during ventricle contraction, whereas diastolic pressure is the resting pressure, happens during ventricle relaxation. So those two things you need to keep in mind. But now let's talk about the pulse. So the pulse is obviously, this is when the diastolic pressure is subtracted from the systolic pressure. So your pulse, your heartbeat in other words. So hypertension is when the blood pressure of the pulse is too high. Hypotension is when it's lower blood pressure. So when you're taking the blood pressure, which we have talked about in the previous one here, maybe their blood pressure is too high, which is called hypertension, or maybe the blood pressure is too low, which is called hypotension. If it's normal, it's normal. If it's too high, too low, you need to make a note of that as well. So normal, with children it does vary on the age. So let me talk about adults next. So basically normal is when the systolic reading, which is the top number, is 120 millimeters of mercury and diastolic is less than 80 millimeters of mercury. If it's 120 over 80, I consider that normal, but of course there's going to be slight variations. If it's 121 over 82, am I gonna think that's too high? Probably not. If it's 119 over 79, am I gonna consider that too low? Probably not. But this is kind of a baseline of what's normal. And as I've mentioned before, blood pressure should be checked every two years because a lot of patients don't go to their family doctor once a year, but they're coming to you for teeth cleanings or whatever dental work they need done. It's good to let them know what their blood pressure is, because if it's too high, you should really tell them and then let them know you should go see your doctor. That could be a sign of something more serious happening. Okay, you guys, so management. This is a common question that I get is prehypertension. What is that? So basically if the top number is between 120 to 139, the bottom number is from 80 to 89, that's considered prehypertensive, okay? So is that cause for concern not necessarily no, but remember you guys, normal is 120 over 80. So anything above, it's not bad, it's not good, it's not bad, you know, but it's considered prehypertension, prehypertension. So if it gets higher, we need to make a note of that, okay? So then we talk about the different stages of hypertension, so stage one. So clients are considered stage one when that top number is 140 to 159. The bottom number, 90 to 99. Keep it simple, this is stage one. So if you're taking the blood pressure reading and you know what the numbers are, you have to put them into a category. Is it normal? Is it prehypertension? Is it stage one or stage two? Depending on the textbook you have, there might be three stages, there might even be four stages or there could be two stages. So it really does depend, but this is a good kind of baseline because you know, prehypertension, as I said, is 120 to 139. For the top number, the bottom number, 80 to 89. Well, what if it's a little bit more? Well, is it higher than 159? Then you're putting them into stage two, okay? So I would make a note of this because it's good to know stage two, I would be more concerned that's extremely high. They should be going to their doctor. Maybe even the hospital, honestly. These days it's very hard to get into see a doctor. You don't want somebody having a medical emergency when they go home alone or maybe there's nobody else there. They're in stage two, hypertension, they didn't know. You don't wanna clean their teeth. You don't want them having any dental work at all because any additional stress might send them over the edge and there could be a medical emergency. So you need to be aware of stage one and stage two. Now, let's talk about temperature. So normal for children and adults, I typically tell people it's lower than 100, okay? Keep it simple. It is lower than 100 degrees Fahrenheit. Anything above that typically means, uh-oh, like something's happening, they have a fever, they need to take Advil, Tylenol, whatever, but anything above 100 is not good. Anything I tell patients 103 or higher, be careful because you might be taking them to the hospital very soon, something is wrong. Pulse, you guys. So let's talk about the pulse. So we talked about the heartbeat before. We talked about blood pressure, but let's kind of put it down now into the pulse. So the pulse is the force of blood through an artery created by a heart's contraction. So the heart is contraction. The heart is contracting, okay? So that is the pulse. It is either fast, slow, regular, irregular, full, strong. In the dental office, we're not as concerned with the pulse and kind of is it fast, slow, steady? We're just more concerned of how many beats per minute, okay? That is the main thing for us. So how many beats per minute? For children ages one to 10, 60 to 140 is normal. It tends to have more than an adult. So, but if you're looking at children that are 10 years or four to adults, normal is 60 to 100. So think adults, okay, think 60 to 100. For children, just to keep it simple, think 60 to 140. So if it's higher for children, that is normal because they have a pulse that is going to be quicker. But you need to know also tachycardia, which is when there is more than 100 beats per minute. If it's too slow, less than 60 beats per minute, that is this one here, bradycardia. So bradycardia and tachycardia has to do with the pulse. Not with the blood pressure has to do with, well, I guess it kind of does, but has to do with the pulse in this case to keep it simple. Respiration, so how the client is breathing in and out. When you're checking this on your patient, don't tell them you're checking because their breathing tends to change. What I do is I'm going to go and check the pulse. I'm going to count it for 30 seconds and then times that by two to get to one minute. The other 30 seconds, I keep my fingers on their pulse, but I look at their chest to see what's happening there. And then I count for 30 seconds the respiration. They don't know I'm doing it. It's not going to change. That way you can really determine what it is properly because if they see you doing it, their breathing is going to change and then you can't really get a proper baseline of what it should be, okay? So normal is 12 to 20 for teens to adults. For preschool children, 20 to 25. Older children, 15 to 25. So the rule of thumb here is children breathe faster. That's normal. Teens to adults is typically up to 20 is normal. Now for the American Society of Inesitesiologists, this is when if they're putting the patient to sleep for say the wisdom teeth, dental surgery, whatever, they look at all of the different vital signs. They look at the blood pressure. They look at the pulse. They looked at all of that. And then they kind of look at other things too. Do they have asthma? Do they have diabetes? Do they have high blood pressure? So these are all of the different categories that you need to be aware of. Feel free to take a screenshot of this. If you want, I have summed it down to it being very simple. So ASA one, two, three and four. So basically one is normal, they'll be fine, okay? There's no extreme diseases. They can handle it. They don't have high blood pressure through the roof. They'll be fine. Class two is basically you can tell they're nervous. They might also have diabetes, asthma or hypertension, but they're still okay. You're not worried about it. A lot of people do have dental anxiety, but does that mean they can't be put to sleep? Well, those people should be put to sleep because they're anxious, but can they handle it? Maybe, maybe not. This is kind of what they look at. Stage two is okay. Stage three though, okay? So this is when somebody has a lot more going on. They might have had a heart attack or there's a greater chance of having one because they have angina. They might have diabetes, but it's controlled COPD. They might have trouble breathing overall. Hey, they might even be a heavy smoker. So they can probably do routine dental care, but there's going to be a risk. You're going to monitor them for medical emergencies. And class four is there's a lot going on. They've had a heart attack six months ago. They have a lot of chest pains. Perhaps they have diabetes that's not controlled. They have high blood pressure. You should not be doing any dental care on them because they need to get their disease or their condition under control first. So you guys, I hope that helps. Let me know if any questions, kind of just to sum it up, blood pressure. What's normal? You need to know what's normal. What's too high and what is too low because as dental professionals, we need to be able to prevent a medical emergencies. And that starts with the vital signs. If you're not taking vital signs, you don't know how healthy the patient is. Even if the patient says they're healthy, they might not be because they haven't had their vital signs taken. They're not going to the doctor. So definitely something that we need to be aware of. So let me know you guys if any questions and I'll talk to you guys in the next one.