Orthostatic vital signs

[ERDoc]

Reading through one of the other threads made me want to start a new one and ask:

1. What constitutes a positive finding when performing orthostatics?

2. What is your method for obtaining orthostatics?

I'll refrain from explaining why I ask until a good discussion has been enjoyed by all.

[scubanurse]

I always was told a change in BP systolic >20mmHg and >10bpm constituted a positive finding.

I always tested the patient on the same arm laying down, immediately after sitting up to a high fowlers type position, and then again when the patient went to standing if possible.

I always took the patients statement of feeling dizzy or the symptoms worsening as a positive sign as well.

As someone who has POTS, I tried to be pretty acute to S/S that could be orthostatic in nature and when possible and time permitting I would check for it.

[tniuqs]

ER doc ... are you asking about orthostatic hypotension ? As Kate is suggesting as a positive finding, as in a change in 10 to 20 mmHg from lying to sitting position ?

OR is this just another EMS myth ? I am sensing an ass kicking here is forthcoming LOL ----- >

Unabashedly I "have" been under the impression that this is an indication the "tank" may be low, due dehydration or a hypovolemic component (dependant on underlying pathology) although I believe in some endocrine disorders its a more than common finding .. argh back to goggle and studies AGAIN !

Good topic

[ERDoc]

You are correct in the definition but what I am asking about is what vital sign changes make your orthostatics positive. How exactly do you measure them?

[tniuqs]

Not exactly certain of what your asking for pulse, resps , BP, colouration, skin turger.

I would expect, say if I observe a relative tachcardia and change in BP correspondingly (sp) that dehydration or a low volume may be a culprit but if I observe no response in pulse rate or borderline brady I would be asking if patient is beta blocked, doing any labs in field for say hypothyroidism is not available or in the case of a "blue hair" my favourite demographic actually, ask for the chart .. but maybe I should stand down and let someone further up the Darwinian ladder have a crack at the answer. before I completely make a fool of myself in reading comprehension.

[ERDoc]

No fools around here. Maybe I'm not explaining myself very well. How much of an increase in HR and/or decrease in BP do you need to have before you can say someone is orthostatic? How much time is allowed between measurements?

[Richard B the EMT]

"Sir, how can I help you if you keep passing out when you stand up, as I'm attempting to ascertain your orthostatic blood pressure changes?"

(I think attributed to Steve Berry, of "I am NOT an Ambulance Driver" fame)

[tniuqs]

LOL Richard... or maybe Kelly Grayson .. he is known to have a few knee slappers "his own self' that (self acclaimed coon ass Louisiana good ole boy.

ER doc I woulds say an increase of 10 % in pulse rate and changes of 20/10 ... time would be more of a consern if pulse did not return to base line (say 5 minutes) .. i know this is controversial.

Personally a one beer infusion makes me dizzy when standing up too quickly, that when I realize its empty and need another, its sounds like a good justification to me re: "orthostatic hypotension" so I am going with that, as an answer for door number one.

Edited August 14, 2011 by tniuqs

[scubanurse]

As far as time... you shouldn't allow too much time to pass, which is why I always started just as they stood up and so about 30-60 sec have passed before I get a new BP...

I know with me, I feel fine for the first second or two and then the dizziness hits.

[DwayneEMTP]

As far as time... you shouldn't allow too much time to pass, which is why I always started just as they stood up and so about 30-60 sec have passed before I get a new BP...

I know with me, I feel fine for the first second or two and then the dizziness hits.

I've not used this much, and to be honest, when I do I don't do a thorough job of it. If I sit them up and they are dizzy and/or their pulse increases significantly I've used this as a positive sign, though don't report it as positive orthos.

But I believe that the time from position change to time of reassessment of vitals should be two minutes or more?

Dwayne