I read with some joy responses in EMN's January letters section about an article by third-year emergency medicine resident Andrew Risner, MD (“The Vital Signs are Always Vital,” October 2000, p. 12). The reason I was happy is that I just finished writing a text on the vital signs, the first one ever published. The title is The Vital Signs and Resuscitation, and the publisher is Landes Bioscience of Georgetown, TX. It was due to be released in March.
I had missed Dr. Risner's article, and just caught the letters in January (“Another Vital Sign: Pain,” p. 4, and “Another Vital Sign: Level of Consciousness,” p. 28) discussing this topic. In fact, level of consciousness is a fifth vital sign, and has been for many years, courtesy of EMS. The book has a complete chapter on the subject. The first chapter elucidates the history of vital signs, and the last one deals with “Future and Controversies,” which addresses the issue of other potential vital signs (pain, pulse oximetry, orthostatics) mentioned in the article and in one of the letters, and why they do not fulfill vital sign criteria.
I am very glad the interest is there. Dr. Risner's article (plus level of consciousness, minus three of his other vital signs) could be an introduction to my book.
Joseph V. Stewart, MD