12 – Neuro – Orthostatic Hypotension

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 *