How do you treat persistent orthostasis? How much of a drop do you allow, especially if their dizziness is inconsistent?
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.
Adele Myszenski, PT
Adele Myszenski is currently the supervisor for the Medicine/Surgery team at Henry Ford Hospital in Detroit, MI. HFH is a level 1 trauma, teaching hospital and the recipient of the 2011 Malcomb Baldridge National Quality Award. A 2001 graduate of Wayne State University, Adele practices primarily in the adult medical and surgical and neonatal ICUs and a variety of med/surg populations. She is responsible for creation, development and implementation of competencies across the service line for lab values, ICU, VAD and other areas. In addition, Adele currently serves as expert superuser for EPIC and allied health site leader for CPM for EMR go-lives at HFHS.
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