Orthostatic/postural vital signs

[ERDoc]

Curious if standing a patient up and checking a pulse (or waiting for a "I feel dizzy") would have similar predictive power as orthostatic V/S.

Ah, but state what othostatic VS are and your source.

 

[NYBLS]

Curious if standing a patient up and checking a pulse (or waiting for a "I feel dizzy") would have similar predictive power as orthostatic V/S.

I feel like thats more telling for the patient as well than saying "holy wow, your blood pressure dropped 30 points!" Especially when attempting to convince a patient to be transported.

 

[Brandon O]

Curious if standing a patient up and checking a pulse (or waiting for a "I feel dizzy") would have similar predictive power as orthostatic V/S.

The literature actually suggests that provocation of symptoms ("I feel dizzy") is the most predictive -- or at least the most sensitive -- provoked tachycardia is next best, and actually BP drop is least. So if the latter is what you're referring to, yes.

Unless I'm misremembering that. It's been a while.

 

[EpiEMS]

Ah, but state what othostatic VS are and your source.

Not sure if I follow -- do you mean how much change in HR and/or BP would qualify as + orthostatic?

The literature actually suggests that provocation of symptoms ("I feel dizzy") is the most predictive -- or at least the most sensitive -- provoked tachycardia is next best, and actually BP drop is least. So if the latter is what you're referring to, yes.

Unless I'm misremembering that. It's been a while.

Sounds right to me -- my (late-night) Google and PubMed search showed the same.

Roberts and Hedges’ Clinical Procedures in Emergency Medicine (2013 ed.), pg. 16 cites this study, a meta-analysis (admittedly, an older one) which was summarized as: "When clinicians evaluate adults with suspected blood loss, the most helpful physical findings are either severe postural dizziness (preventing measurement of upright vital signs) or a postural pulse increment of 30 beats/min or more." I'd like to do some more digging, but I would go with Roberts and Hedges on this one (again, pg. 16): "[T]his procedure [orthostatic vital sign testing] has limited proven value, and clinical interpretation of orthostatic changes in blood pressure and pulse varies widely."

 

[MackTheKnife]

So for those of you using it to convince patients they're sick, are you actually recording vitals? It seems like this would work equally well just by demonstrating their symptoms to them. (Actually, this would be more evidence based as well...)

Are you saying sx' s are more evidenced-based than objective vital signs?

 

[MackTheKnife]

Well yeah. Otherwise it's just "stand up and tell me if you're dizzy". I found that BLS loves to take orthostatics. It gives them something to do.

Tongue in cheek comment, or are you being condescending towards Basics?

 

[Brandon O]

Are you saying sx' s are more evidenced-based than objective vital signs?

In this case, yes, reproduction of symptoms is more predictive than trying to pick an arbitrary cutoff for vitals aberrations.

Edit: I can dig up the references if you'd like, I have them somewhere.

 

[MackTheKnife]

In this case, yes, reproduction of symptoms is more predictive than trying to pick an arbitrary cutoff for vitals aberrations.

Edit: I can dig up the references if you'd like, I have them somewhere.

OK. I think you are right but are subject to attack by those on here who need to have several peer-reviewed studies before they can accept anything. Medicine is art and science.

 

[teedubbyaw]

Absolutely do it often. I certainly don't do a textbook method. These pt's are usually already laying or sitting -- grab a BP, have them stand up and if they're dizzy/light headed, then +orthos. Get a auto BP as they're standing and moving to the stretcher. +drop +HR, boom.

 

[Ewok Jerky]

Ortho static VS are defined as a drop in SBP of 20 or raise it HR of 30 within 5 minutes.

Routinely used in AMAs of hypovolemic cases and discharges from the hospital when admitted for hypovolemic issues.

 

[Carlos Danger]

In what very common disease process would orthostatic VS be unreliable, and why?

 

[Carlos Danger]

In what very common disease process would orthostatic VS be unreliable, and why?

I was thinking of patients with advanced diabetes. They often have a peripheral neuropathy that results in significant autonomic dysfunction. This results in a higher resting HR and BP, and lack of compensatory hemodynamic changes in the setting of vasodilatory or hypovolemic events. You may not see a compensatory tachycardia with an orthostatic test even if they are hypovolemic.

 

[Zredmond]

I mainly use it on syncopal episodes to decide if I am comfortable allowing pt to AMA without ALS on scene. I've had a lady at 100/68 sitting, and as soon as I stood her up it dropped to 70/40. Obviously I'm not gonna kidnap her, but you can bet I got ALS to take over.

 

[MackTheKnife]

Did you take her standing BP right away, or wait two minutes and then take it?