Removal of orthostatics in abdominal pain

[cwilliams17]

OK now i'm really confused. What does RSI have to do with the original question about orthostatics for abdominal pain?

[Iowa Medic]

I have not had an opportunity to speak with any of the physicians as I was off today... hence the post here

The previous protocol simply stated

"Treat for pain, NPO, orthostatic challenge and consider bolus if indicated"

Now it reads

"Treat for pain, NPO, consider bolus"

I suppose it could be nothing more than they no longer felt the need to specifically state "orthostatic challenge" but in my experience when it comes to the state protocols they have no issue with breaking it down to the point where the lowest common denominator could keep up. Thus I was curious if I was missing a glaring issue that would cause the removal of orthostatics from the protocol... harm to patient, inappropriately interpreting the results, relying too heavily on the orthostatic reading with regard to treatment or God forbid unable to properly perform the orthostatics

Sorry for the confusion and I appreciate any insight or speculation

OK now i'm really confused. What does RSI have to do with the original question about orthostatics for abdominal pain?

It was an example of a skill being removed from the protocol and the reason for the skill being removed. Considering my question was "What is the rationale behind the removal of orthostatics"

I was looking for

"Orthostatics were removed from the protocol because it was causing spontaneous combustion in elderly adults"

I really apologize and even after reading my posts again I'm not sure where I failed to get my point across... perhaps it's my lack of sleep and attempting to go from grave yards yesterday to 0600 to 1800 tomorrow

[paramedicmike]

I have not had an opportunity to speak with any of the physicians as I was off today... hence the post here

When you do let us know. I'm curious, too. It's usually a good thing to understand how and what the docs are thinking.

The previous protocol simply stated

"Treat for pain, NPO, orthostatic challenge and consider bolus if indicated"

Now it reads

"Treat for pain, NPO, consider bolus"

I suppose it could be nothing more than they no longer felt the need to specifically state "orthostatic challenge" but in my experience when it comes to the state protocols they have no issue with breaking it down to the point where the lowest common denominator could keep up. Thus I was curious if I was missing a glaring issue that would cause the removal of orthostatics from the protocol... harm to patient, inappropriately interpreting the results, relying too heavily on the orthostatic reading with regard to treatment or God forbid unable to properly perform the orthostatics

I would read it the same way with regards to not needing to specifically state the procedure. If you're going to consider a bolus that's one of the tests you can use to help reach your decision.

As for the lowest common denominator, well, that's a thread unto itself. And there have been many here attempting to address that very issue.

I really apologize and even after reading my posts again I'm not sure where I failed to get my point across... perhaps it's my lack of sleep and attempting to go from grave yards yesterday to 0600 to 1800 tomorrow

Well, you wrote it. So it's going to make sense to you no matter how many times you read it. The rest of us, however, often lose things in the internet translation and wind up scratching our heads. It happens to me quite often. No worries.

[Kiwiology]

Orthostatic hypotension is a non-specific indicator of low blood pressure which as we all know can be caused by 300 different things

If it were my educated guess, it was removed because it's got no real value

[Doczilla]

Sensitivity and specificity of orthostatic vitals are relatively poor. While there may be certain instances that you might consider it, I don't see a need for a requirement in the protocol. Because of that sensitivity and specificity, it won't change much that you're doing.

'zilla

[HellsBells]

Personally, I've never routinely tested orthostatic changes with a CC of abdo pain. Perhaps in the case of presyncope, or dizziness on ambulation, perhaps.

However, don't really know why they changed your protocols. Maybe its due to possiblity of a syncopal episode, and further injury from a fall?

[ERDoc]

I don't see much use in orthostatics with abd pain, except under certain circumstances. I think they are leaving more to a judgement call than putting it in the protocol. The way the protocol was written, it sounds like you are expected to do orthostatics on ALL abd pain pts, which I don't think is what they meant.

[WolfmanHarris]

Leaving aside the protocol specific question, which is something of a non-starter, why don't we discuss the concept of orthostatic hypotension in a bit more depth?

With the specificity and sensitivity of orthostatic hypotension being so limited, when would do you use it? What is your thinking here? Does it hold up under scrutiny?

The only time I can think of that I've regularly checked orthostatics is in the context of the syncope patient. When presented with a syncope patient, with an unremarkable incident history, unremarkable cardiogram and normal blood sugar who is largely asymptomatic at time of assessment, I've been in the habit of taking my initial vitals in a supine or semi-sitting position, then sitting, then standing. My thinking here, what of it there is, is that I want to see how the Pt. compensates and that they can now maintain their pressure.

Now, is my rationale here sound?

[m0nster986]

I agree, and let us all remember that protocols are really more like "guidelines." The ability to critically think through our calls and to do what is in our patients' best interests is what will really benefit our patients.

[ERDoc]

I agree, and let us all remember that protocols are really more like "guidelines." The ability to critically think through our calls and to do what is in our patients' best interests is what will really benefit our patients.

That depends on where you practice. In some areas, protocols are gospel.