Vital Signs - Use THRO2BS!

Dear Colleagues

Have you ever considered that vital signs should be presented in a clearly defined and logical format?

Over my years teaching in Japan, I have experienced many hundreds of presentations. From such interactions, there appears to be no standardised way to present the vital signs.

Moreover, it is commonplace for the respiratory rate, and the numerical rated pain scale to be missed off from the vital signs.

Something I have found somewhat strange is the use of the term “body temperature.“ In fact, in medicine are we not always measuring the temperature of the body? Therefore, why is it important to mention the word “body“ at all? The simple fact is that we do not need to mention the word “body”; this is implied, because when the presentation is taking place it is always with respect to the patient in the first place and nothing else. In the UK, as an example, all that is mentioned is “The patient’s temperature was 37ºC.” 

In order to create a more streamlined and logical way to present the vital signs, I created a mnemonic that incorporates not only the usual vital signs, but also conscious level and the numerical rated pain scale.

This mnemonic is called THRO2BS (pronounced as THROBS; ‘O2’ within THRO2BS reminds us of oxygen! O2 is related to pulse oximetry, and hypoxia leads to impaired Orientation!). The word ‘throb’ actually means ‘beating with a strong regular rhythm.’ This is of course very apt for referring to vital signs which includes the heart rate!

The mnemonic is as follows:

T - Temperature

H - Heart rate 

R - Respiratory rate 

O - O2 saturations (pulse Oximetry)

Orientation e.g. AVPU scale / GCS

B - Blood pressure

S - Severity of Pain (x/10 on a numerical rated scale)

As you can appreciate from the above, all of the vital signs are in a designated order. The temperature is also next to the heart rate and therefore, it is easier to detect a relative bradycardia when looking directly at those first two parameters.

The respiratory rate is also next to the pulse oximetry, which again is therefore easy to detect an abnormality of breathing. 

Severity of pain was added because many physicians forget to ask about pain. Therefore, by memorising the mnemonic ‘THRO2BS,’ this ensures that the doctor does not forget to measure the important often missed signs of the respiratory rate and the pain scale.

I hope that it can be used nationwide, and can help to standardise medicine better.