How Do You Treat Persistent Orthostasis?

Question

Answer

I allow a drop of 20 mmHg and it depends on the patient’s symptoms as well.  If they have gone from 120/80 to 100/70, but they are not dizzy, I may still treat.  The best way we treat persistent orthostasis is bringing in a tilt table and do 5 degrees increases.  We check the blood pressure every two minutes to make sure the patient is not getting too dizzy and that the blood pressure is not changing.  I couple that with what the patient’s symptoms are.  You can sometimes tell if the dizziness is just a complaint because they are sick and tired of trying it, or if they really are dizzy based on the eyes.  I often look at the eyes.  If the eyes are rolling back in the head, they are about to pass out.  In that case, I would crank the tilt table back down.  If you do not have access to a tilt table, some beds can tilt.  You can also have them come into side-lying and help them come up in incremental doses to sitting on the edge of the bed.  I would caution you not to transfer them to the chair and sit them there.  Make sure they are in a safe position to get back to bed in a hurry if you are worrying about their blood pressure bottoming out. 

This Ask the Expert question answer taken from the course The Essential Role of Lab Values and Vital Signs in Clinical Decision Making and Patient Safety for the Acutely Ill Patient.