Had a patient who just had spinal surgery, and her BP drops dramatically when we stand her. Nurses say meds are not the issue, they just have ruled out everything.
Made a silly suggestion: compression stockings.
Could venous pooling in her lower extremities be an issue here? I once cared for a high paraplegic patient, and it was essential for us to put compression stockings on her before putting her in a standing frame...something with the sympathetic nervous system. The patient I am asking about is not paraplegic, but I wondered if the trauma of surgery could have a temporary impact this way. So, could it be a neurogenic vascular thingey?
That wont help. Blood patches are done for bad dural headaches d/t csf leaks, etc. It wont help postural hypotension. Injecting a tablespoon(roughly) of blood into someone's spinal column may help to raise the pressure in the dural space...not in a patient's vascular space.
If this orthostatic hypotension is new, it's related to either 1) immobility/bedrest
2) Pain, 3) dehydration. ...(these are the three best guesses and may be wrong).
If it's old...and has been bad enough for the patient to pass-out then the guy needs an evaluation by cardiac/EP as he may require pacemaker or meds or...
if you increase pressure in the dural space in the part of the spinal cord that effects the sympathetic nervous system, would you get increased blood pressure? Would decreased pressure cause hypotension?
Just to clear things up for the poster asking about the "blood patch" idea that got inserted. Here's a clip from the website below. A anesthesiologisst draws the patients blood and inserts it back into their back. It doesn't really apply to the case of the OP, but anytime is a good time to review stuff I haven't done in a while. :)
"Patients often present to the emergency department with post-dural puncture headache (PDPH) after diagnostic or therapeutic lumbar puncture (LP). The headache is severe, starts about 1 day after dural puncture, can be alleviated by lying down, and is often accompanied by nausea, vomiting, or both. Epidural blood patch (EBP), in which autologous blood is injected into the dural space, is advocated for severe or refractory cases."
Just to clear things up for the poster asking about the "blood patch" idea that got inserted. Here's a clip from the website below. A anesthesiologisst draws the patients blood and inserts it back into their back. It doesn't really apply to the case of the OP, but anytime is a good time to review stuff I haven't done in a while. :)
"Patients often present to the emergency department with post-dural puncture headache (PDPH) after diagnostic or therapeutic lumbar puncture (LP). The headache is severe, starts about 1 day after dural puncture, can be alleviated by lying down, and is often accompanied by nausea, vomiting, or both. Epidural blood patch (EBP), in which autologous blood is injected into the dural space, is advocated for severe or refractory cases."
Dinith88
720 Posts
That wont help. Blood patches are done for bad dural headaches d/t csf leaks, etc. It wont help postural hypotension. Injecting a tablespoon(roughly) of blood into someone's spinal column may help to raise the pressure in the dural space...not in a patient's vascular space.
If this orthostatic hypotension is new, it's related to either 1) immobility/bedrest
2) Pain, 3) dehydration. ...(these are the three best guesses and may be wrong).
If it's old...and has been bad enough for the patient to pass-out then the guy needs an evaluation by cardiac/EP as he may require pacemaker or meds or...