Orthostatic vital signs

[armymedic571]

Does anyone find this ironic that in a day and age where EVERYTHING we say and do revolves around evidence based medicine, and it seems ERDoc has found one last Anecdote to debate.....I was slightly astounded, but not surprised that I could not find two pieces of evidence that confirmed each other. Not that I searched very hard mind you. But something that is used often by many fields, I would think would be easier to find.

Cheers.

[ERDoc]

Even with my previous statement I do use it quite a bit in the ER. It's helpful is someone comes in with vague complaints and your not quite sure what is going on. Orthostatics can be positive for more reasons than just dehydration. If I get someone who is orthostatic and I can't explain it due to hypovolemia from vomiting/diarrhea, they are getting a rectal exam to see if there is a GI bleed. I don't think you'll find this being done in the ICU but possibly in admitted pts. It's a quick and simple test even if there is no consensus on what it means.

Edit: I've also used it to determine if therapy has been successful. If I'm treating someone for dehydration and they are orthostatic but after X ccs for fluid they are no longer orthostatic, then I know their tank is being refilled.

Edited August 16, 2011 by ERDoc

[ERDoc]

Does anyone find this ironic that in a day and age where EVERYTHING we say and do revolves around evidence based medicine, and it seems ERDoc has found one last Anecdote to debate.....I was slightly astounded, but not surprised that I could not find two pieces of evidence that confirmed each other. Not that I searched very hard mind you. But something that is used often by many fields, I would think would be easier to find. Cheers.

Since you bring up EBM, here is an article on EBM from the British Medical Journal that I found interesting.

http://www.bmj.com/content/327/7429/1459.abstract

[ateupmedic3033]

Allow the patient to equilibrate for two minutes after each position change before rechecking pulse and BP.

A pulse increase of 20 points or more is considered a significant finding, and IIRC, is a more reliable measure than changes in systolic BP.

And of course, if they're already hypotensive while lying down, don't friggin' stand 'em up.

[tniuqs]

Firstly ERdoc ... brilliant I have forwarded to others that lecture on this topic of EBM.

Does anyone find this ironic that in a day and age where EVERYTHING we say and do revolves around evidence based medicine, and it seems ERDoc has found one last Anecdote to debate.....I was slightly astounded, but not surprised that I could not find two pieces of evidence that confirmed each other. Not that I searched very hard mind you. But something that is used often by many fields, I would think would be easier to find.

Cheers.

Army Grunt ...you make a awesome point, in my hood the EBM new improved "protocols" many time become consensus of Expert Opinion, and in meta studies very often the conclusions drawn and "exclusions" made usurp the most important factor of good clinical observation .. root cause of Diabeties was discovered when ants were crawling in a dogs urine, Pulse Oximetry by a scientist cuting his finger in non destructive testing of building materials .. Salbutamol in a premature delivery .. the list goes on and on..

[armymedic571]

Since you bring up EBM, here is an article on EBM from the British Medical Journal that I found interesting.

http://www.bmj.com/c...9/1459.abstract

ERDoc....I think I pee'd in my uniform.....hilarious......

[scubanurse]

That is awesome!!!! I forwarded that to my dad who used to work a lot with hospitals and EBM

[AnthonyM83]

Getting on this one late.

But most textbooks vary on what qualifies as orthostatic hypotension. It seems to vary between 10-20 mmHg and 10-20 BPM change when taking the BP 2 or 3 minutes (depending on the text) after a change in position (supine to sitting to standing). We'll usually consider feeling lightheaded or dizzy upon position change as a positive result and discontinue the test.

Most times I see it actually used, medics don't seem to wait the full 2 minutes. I would recommend against taking an immediate BP after standing as you might get false positives. You're trying to find the individuals are who remain hypotensive even after a reasonable time to compensate. We all have a drop in BP when standing, but our sympathetic nervous system corrects it.

To the nurse to questions its usefulness in prehospital care, I definitely see your point. But there are chief complaints that might otherwise go BLS (example flu-like symptoms or abdominal pain or frequent urination) where it not for the positive orthostatics.