VITALS are a standardized framework for reviewing acute care charts that aids occupational therapists in making informed clinical decisions before interacting with a patient.
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Standard nasal cannula: low flow oxygen, 1–6 L/min.
Venturi mask: high-flow enriched oxygen of a certain concentration. Provides FiO2 24%–40%.
Face mask: used for patients with nasal irritation. Provides FiO2 40%–60%.
Nonrebreathing face mask: Provides high concentrations of oxygen. Delivers FiO2 up to 90%.
Reservoir cannula: improves the efficiency of oxygen delivery (i.e., patients may be well oxygenated at lower flows).
High-flow warmed and humidified oxygen (HFNC): nasal or transtracheal. Delivers oxygen comfortably at high flows ranging from 30–60 L/min.
Continuous positive airway ventilation (CPAP): provides continuous positive pressure to maintain an open airway.
Bi-level positive airway ventilation (BiPAP):
Mechanical ventilation: a lifesaving intervention for patients with respiratory failure. -
Chest x-ray (to identify pulmonary edema).
Ultrasound (ruling out for DVT).
Magnetic resonance imaging (identifying a brain bleed).
Computed tomography (determining presence of pulmonary embolism).
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Central venous line (CVL)
Arterial line (A-line)
Venous and arterial femoral catheters
Femoral hemodialysis catheter
Femoral intra-aortic balloon pump (IABP)
Pulmonary artery catheter (e.g., Swan-Ganz)
Transvenous or epicardial pacemaker
Extracorporeal membrane oxygenation (ECMO)
Continuous renal replacement therapy (CRRT)
Endotracheal tube (ETT)
Tracheostomy tube (“Trach”)
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Bedrest: (Bedrest might be indicated in the case of new DVT or PE, CSF leak, or new internal bleed.)
Out of bed
Out of bed to chair
Other
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Heart Rate: 50-120 bpm
Systolic Blood Pressure: 80-180 mmHg
Diastolic Blood Pressure: 40-110 mmHg
SPO2%: Above 90%
Respirations: 12-20 breaths per minute
Mean Arterial Pressure (MAP): 70-105 mmHg
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Vasopressors (e.g., norepinephrine, phenylephrine, vasopressin): Consider medical hold when doses are increasing, MAP is <60 or if patient is on >2 pressors.
Sedatives (e.g., propofol, dexmedetomidine, fentanyl): Consider medical hold if patient is obtunded or medical team is unable to safely reduce sedation for therapy.
References
Smith-Gabai, Helen, Holm, Suzanne. (2017). Occupational Therapy in Acute Care. AOTA Press.
Millar, Stacy. Lab values in acute care therapy. Allied Health Ed. https://alliedhealthed.com/wp-content/uploads/2021/01/Lab-Values-Handout.pdf