Physiological observations | Weights associated with physiological observations | ||||||
3 | 2 | 1 | 0 | 1 | 2 | 3 | |
Respiration rate (rpm) | ≤8 | 9–11 | 12–20 | 21–24 | ≥25 | ||
Temperature (°C) | ≤35.0 | 35.1–36.0 | 36.1–38 | 38.1–39.0 | ≥39.1 | ||
Systolic blood pressure (mm Hg) | ≤90 | 91–100 | 101–110 | 111–219 | ≥220 | ||
Heart rate (bpm) | ≤40 | 41–50 | 51–90 | 91–110 | 111–130 | ≥131 | |
Blood oxygen saturation (%) | ≤91 | 92–93 | 94–95 | ≥96 | |||
Level of consciousness | Alert | Verbal, pain, none | |||||
Supplemental oxygen | Yes | No |