Episode 12: Orthostatic Hypotension NPTE Studycast

Featured Expert Bridget Ripa, PT, DPT, NCS, CBIS, CSRS

Notes by Alexis Lancaster, SPT

What is it

 

* A decrease in blood pressure by ≥20mmHg systolic and ≥10mmHg diastolic when moving from a supine to upright position

 

Causes

 

* Cardiovascular system, BP, blood supply to the brain

 

Signs & Symptoms:

 

* Physical signs: pallor, diaphoresis, loss of consciousness (potentially)

* Symptoms pt will report: dizziness, light-headedness, faintness, nausea

 

Differential Diagnosis:

 

* Autonomic dysreflexia

* Look at the blood pressure: AD will have ↑ in BP, OH will have ↓ in BP

* Vertigo, BPPV: b/c of dizziness and light-headedness symptoms

* Generalized nausea from infection, etc.

 

Special tests

 

* Orthostatic testing: monitor BP with position changes

 

Treatment examples:

 

* Immediately: lay the person down, elevate legs to prevent loss of consciousness

* After: talk to the team about BP treatment medications

* Encourage fluids with pt

* Progress upright tolerance with a hospital bed, tilt table to decrease the number of OH episodes/frequency & duration of OH episodes

* Abdominal binders, ace wraps on legs to keep BP up

 

How can it look on the test?

 

* The important part: recognizing OH and manage it

* Emergent scenario: decide that it’s OH and what you would do about it

* May need to differentiate between OH and more emergent conditions, such as AD

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