Better than vital signs, and faster

First parameters we usually look at in a patient are usually vital signs - temperature, blood pressure, pulse, respiratory rate - and sometimes plus - O2 saturation, pain score; and in trauma - blood sugar and hematocrit.

But is that a good first thing to look at? Is it adequate and fast enough?

In trauma, we learn to do primary survey, the ABCDE, for the critical trauma patients.

What about the non-trauma? What is better than the vital signs?

I propose:-

1. General appearance = spot diagnosis - This should come before numbers - the vital signs.
1. Agitation - gives a clue about dyspnea or unstable BP, or probably upper airway obstruction, the first A in ABCDE; and pain
2. Drowsiness/quietness - gives a clue about hypotension, fever, hypoglycemia
3. Air hunger/gasping - obviously airway, and breathing
4. Active blood loss, or history of blood loss
5. Chills/perspiration - may be fever.
2. Rapid cardiovascular exam
1. Is the pulse strong and slow?
3. Rapid respiratory exam
1. Head movement/air hunger?
2. Any basal lung coarse crepitation?
3. Any wheezing/rhonchi?
4. Rapid KUB exam
1. How much urine are there in the urine bag?

This is just an idea, though.