Orthostatic vital signs

[ERDoc]

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

And what do you consider significant?

[tniuqs]

You really spiked my interest in this area ERDoc ... it will be my "safety talk topic" early dark wake up on a project I am deployed, Its really hot here and the workers are not conditioned to this heat nor are the providers for EMS in evaluation.

btw I peeked at the american journal of nursing, no link provided to their suggestion's, just to keep this excellent teaching tread going.

cheers

Edited August 15, 2011 by tniuqs

[paramatt_]

Interesting topic Doc....I'm looking forward to hearing what you're getting at.

Like the others I would say that a pulse rate increasing above 20bpm and a BP change greater than 20mmHg systolic or 10dia would constitute positive.

I also remember reading something about changes can may not be acute (i.e. right when someone stands) so to repeat the check between 3-5minutes of standing. I suppose there would also be inconsistencies depending if the person is laying flat or sitting before standing....with the supine to standing patient having the biggest potential for orthostaitc change.

[DwayneEMTP]

And what do you consider significant?

Again I'm afraid I don't have a hard number. In one patient I might feel that the pulse goes from full at 72 to slightly thready at 90 and take that as a positive sign. Another might be full at 72 yet bounding at 82 and I consider that significant.

Actually, I wanted to lie really bad on this because I'm kind of embarrassed to admit that I've never really taken orthos very seriously. It's like the GCS, it seems everyone does it but me, and has really good reasons for it, but I just fail to see them.

I too am excited to see where this thread is going.

Dwayne

[BushyFromOz]

Again I'm afraid I don't have a hard number.

Wow, same here, never thought of this before, nor do i recall reading anything on it.

Perhaps the point is that they dont have to exhibit a marked change in vital signs, but that they become symptomatic? If patient become symptomatic due to lack of parasympathetic response leading to symptoms even though they still have technically "normal" vital signs they are still symptomatic and hence have reduced cerebral perfusion?

[zippyRN]

and how long do you have your patient in sat or laid before starting your series of blood pressure recordings ...

personally unless you are working as an advanced practitioner in a system which might divert certain classes of calls away from transport to the ED , Orthostatic hypotension screening by EMS personnel is a waste of time for the following reasons

1. if you do it properly you drastically increase your scene time

2. it has no value as a screening tool to decide if ALS is needed ( see 1 above) and it is of little value in making decisions regarding which facility to transport to if thechoice is different EDs

however it has it's place in Acute and emergency medicine ...

also a finding of postural hypotension without all the other tests examination and the like is only a small part of the picture.

[scubanurse]

I think the relevant use in EMS would be, if you go to stand a patient up and they become very dizzy and lightheaded... probably wouldn't hurt to put some fluids into them.

I don't believe in increasing on scene time if you don't have to, but I do believe in obtaining as much information about a patient as possible within a reasonable amount of time.

[tniuqs]

and how long do you have your patient in sat or laid before starting your series of blood pressure recordings ...

personally unless you are working as an advanced practitioner in a system which might divert certain classes of calls away from transport to the ED , Orthostatic hypotension screening by EMS personnel is a waste of time for the following reasons

1. if you do it properly you drastically increase your scene time

2. it has no value as a screening tool to decide if ALS is needed ( see 1 above) and it is of little value in making decisions regarding which facility to transport to if thechoice is different EDs

however it has it's place in Acute and emergency medicine ...

Interesting opinion, so its useful in some areas restricted to Acute Care Medicine ?

I do not see in the thread any suggestion that this could be used as a method for triaging a patient or choice of destination facilities nor in fact delaying transport in those vital seconds for the trip from Nursing home to ER .

Frankly this would help me guide care for a suspect geriatric and assit to decide to pop a line in for systemic re hydration problem, for those that deal with this routinely the geriatric population is notorious for forgetting to drink fluids.

also a finding of postural hypotension without all the other tests examination and the like is only a small part of the picture.

Agreed is just part of the picture but is a 5 minute evaluation something that is frowned upon in your service, that to be dilegent in a "field" work-up ? I believe that Robert C. Knies, RN MSN CEN just may disagree with your opinion.

[Bieber]

I've always taken positive orthostatic changes as a BP change of 20 or a heart rate change of 10 bpm. Although I was taught that you were supposed to wait a couple of minutes between taking vital signs.

Honestly, I haven't used it as much as I probably should.

Here's another question I have for you guys, when do you decide to give fluids to a patient you suspect is dehydrated?

[armymedic571]

I would have to say that a 20 point increase in systolic and a 10 point drop in diastolic would sufice as a baseline for Blood pressure.

I have always used a 20 point increase in pulse rate, but can't seem to verify that with a legitimate reference.

The same goes for time......it seems that different references have different criteria, and that some some even use heart or pulse rate as an indicator....

Very interesting indeed......ERDoc, it seems I picked a good evening to log in after a long hiatus from this site.......