Orthostatic Vital Signs

Brandon Oto said:
Patient: [hypotensive, lying lateral in a pool of blood from his butt]
Us: [help him sit up to move him to a stairchair]
Patient: [immediately seizes]
Us: Hmm... whoops.
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Yeah, something like that. Or the guy who is cold, pale, wet, pressure of 60/p, and had syncope. Same thing, sit him up, watch him pass out.

Which is why I condemn it.
 
Too Old To Work said:
Useless in EMS for the most part. Especially since very few people at the BLS or ALS level are taught what they mean or how to interpret them.

I've seen many cases where people who should know better will sit or stand up a patient who is already hypotensive to see if they are "postural". They find out that they are when the patient loses consciousness.

If the patient is hypotensive lying down, they are going to be hypotensive sitting or standing.

If the patient is normotensive lying down, and has a pulse rate in the normal range, you aren't going to learn much by checking postural vital signs.

Just more long taught and essentially useless EMS knowledge along with looking for battle sign, Raccoon eyes, and of course blown pupils. All of which are late signs and the absence of minutes or hours after an injury tell you nothing about the patient's condition.
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Thank you so much. This is the type of feedback that I was looking for when I posted the original thread.
 
We just started going over this in class and according to our book you should use orthostatic vitals when you suspect shock.
 
You're supposed to have your (presumably) critically injured trauma patients stand up for a series of vital signs? That's the most absurd thing I've ever heard.
 
I've only really seen it used when we are posted up at concerts (especially all-day events) and knuckle-heads spend all day in the sun and have a beer and a shot of tequila as Breakfast, Lunch, and Dinner. As has been mentioned, a lot of the other signs & symptoms of dehydration seem to be absent from idiotic twenty-somethings.
 
Not sure if it's been mentioned, but one test for dehydration is a drop in BP, especially upon standing.

Edit: Apparently it has been!
 
rescue1 said:
You're supposed to have your (presumably) critically injured trauma patients stand up for a series of vital signs? That's the most absurd thing I've ever heard.
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Forgive them...

They know not what they do...

I would point out that there are 4 classes of shock.

Class I (15% or less total blood volume) being largely asymptomatic.

Class II ( 15-30% total blood volume with an estimated blood loss of between 800-1500ml) will be discovered by orthostatic pressure changes. Urine output maintained

Class III (30-40% total blood volume estimated 2000ml) anxious or combative with decompensation and drop in urine output.

Class IV (>40% blood volume) imminent circulatory collapse.

In EMT class, the curriculum focuses on class III and class IV. Identifying a patient is these states is rather a no brainer. But they are not nearly as common as Class I and II.

The purpose of orthostatics in a potential shock patient, which for the purposes of this discussion, we will just call hypovolemic for simplicity, is meant to distinguish class I (do nothing) from Class II (compensation benefitted by supportive care.)

From the EMS standpoint, the practicality is:

Would the patient benefit from supportive therapy? (IV infusion) or just a ride (turf to BLS, BLS rides call, or not call for ALS)
 
Ah, OK. I stand corrected.

My course, unsurprisingly, never even mentioned Class I and II shock.
 
Whatever you do: when pts BP dropped 44 points from supine to sitting do NOT stand them up. an Engine crew did that while waiting for us to getting there; hard to write in the report how someone with a GI bleed needed sutures in their forehead
 
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