true orthostatics

OK. I have seen differing techniques for orthostatics.

First laying down for the BP check for at least 5 minutes.

Then patient stands. Do you check soon after they stand or wait 2 minutes? I am seeing both. Doesn't the body acclimate if you wait the 2 minutes?

I have heard both, too. It depends on the Doc..Its been my experience, that when someone is "dehydrated", its going to be different anyway - no matter how long they stand.

Some Docs disagree on whether or not the range is increased by 10, or decreased by 10. Some say either way is a positive.

i found this when looking for a definitive answer. may vary from place to place, but sounds reasonable. we ususally check lying, sitting and standing.

http://www.iredellems.com/personnel/employees/icems%20protocol%20web/procedure%20pages/orthostatic_bp.htm

orthostatic blood pressure measurement

clinical indications:

ø patient situations with suspected blood/fluid loss/dehydration.

ø patients > 8 years of age, or patients larger than the broselow-luten tape.

procedure:

a. assess the need for orthostatics.

b. obtain patient's pulse and blood pressure while supine.

c. assist patient to a standing position and remain standing for one minute.

d. if pulse increases by 20 bpm or systolic blood pressure decreased by 20 mmhg, the orthostatics are considered positive.

e. if the patient is unable to stand, orthostatics may be taken while the patient is sitting with feet dangling.

f. if positive orthostatic changes occur while sitting, do not continue the standing position.

g. determine the appropriate treatment based on protocols.

h. document the procedure, time, and patient response in the acr.

we do lying supine, sitting with feet dangling and standing if able.

Your link is broken.

We always did them lying after 10 minutes, then immediately upon sitting then immediately upon standing. This was per the request of our cardiology group where i use to work. Everywhere you go they have different norms. I have had a nurse and a paramedic in the ER where I work now tell me that I needed to wait 1 minute after sitting and 1 minute after standing. It seems ridiculous to ask each Doc that orders orthostatics which technique they prefer. I would love some kind of final word on this.

just do whatever! :)

The other goal in cardiology, of an orthostatic BP, might be to prove (or find out if) they are ok to come off that 6+ hr. bedrest post cath lab procedure. So I took my time getting them up. I might remove a foley while they sit up, change a gown, put new socks on them, etc. If there is truly a problem it will show up regardless of how long it takes me to get them up.

Orthostatics in the ER is to check for dehydration, orthostatics in cardiology is to check with cardiac output - you are checking for different things:

In the ER, you should wait one minute when you change positions. That is because normally, there is a difference if you do it as soon as position is changed - so you would have a lot of false positives. However, if the BP decreases by 20mmHg (diastolic) and/or the heartrate increases by 20bpm and/or you have a resting tachycardia of >120 bpm in a normal healthy adult, you can assume they are dehydrated.

Here's my source:

http://enw.org/Research-Orthostatic.htm

And...I don't mean to be personal, but if you don't know what you are measuring or why you are measuring it, you should be asking questions.

Very nice link.

Orthostatics in the ER is to check for dehydration, orthostatics in cardiology is to check with cardiac output - you are checking for different things:

In the ER, you should wait one minute when you change positions. That is because normally, there is a difference if you do it as soon as position is changed - so you would have a lot of false positives. However, if the BP decreases by 20mmHg (diastolic) and/or the heartrate increases by 20bpm and/or you have a resting tachycardia of >120 bpm in a normal healthy adult, you can assume they are dehydrated.

Here's my source:

http://enw.org/Research-Orthostatic.htm

And...I don't mean to be personal, but if you don't know what you are measuring or why you are measuring it, you should be asking questions.

Thanks for the information. This looks to be the best answer I've heard yet.