Download Patient Assessment – VS – Orthostatic

EMS SKILL
PATIENT ASSESSMENT / VITAL SIGNS
ORTHOSTATIC
PERFORMANCE OBJECTIVES
Demonstrate competency in obtaining accurate orthostatic vital signs.
CONDITION
Demonstrate competency in taking an accurate blood pressure and pulse to determine orthostatic vital signs on a live model with the
patient lying supine, sitting and standing. Necessary equipment will be adjacent to the patient or brought to the field setting.
EQUIPMENT
Live model, large/medium sphygmomanometer, stethoscope/dual teaching stethoscope, timing device, gloves.
PERFORMANCE CRITERIA
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Items designated by a diamond () must be performed successfully to demonstrate skill competency.
Items identified by double asterisks (**) indicate actions that are required if indicated.
Items identified by (§) are not skill component items, but should be practiced.
Reading must be within +/- 6 mm/Hg for blood pressure and +/- 4 beats/minute for pulse of examiner’s determination.
PREPARATION
Skill Component
Key Concepts
 Take body substance isolation precautions
 Mandatory (minimal) personal protective equipment – gloves
PROCEDURE
Skill Component
Key Concepts
 Have patient lie supine for 1 full minute:
 Appropriate cuff size must be selected or inaccurate readings will be
obtained.
 Auscultate blood pressure
 Assess pulse for rate, quality, and regularity
 The supine position for 1 minute allows patient to equilibrate to the
highest pressure reading.
 If hypovolemia is suspected, treat as orthostatic positive. DO NOT
sit or stand patient up.
 Have patient sit for 1 full minute:
 If signs of dizziness or syncope occur, place patient in supine
position and discontinue test.
 Auscultate blood pressure
 Assess pulse for rate, quality, and regularity
 Have patient stand for 1 full minute:
 Decrease of 10-20 points in either the systolic or diastolic pressure
indicates positive orthostatic change.
 Auscultate blood pressure
 Assess pulse for rate, quality, and regularity
 Increase of 10-20 beats per minute in pulse rate indicates positive
orthostatic change.
REASSESSMENT
(Ongoing Assessment)
Skill Component
Teaching Points
 Priority patients are patients who have abnormal vital signs, S/S
of poor perfusion, if there is a suspicion that the patient’s
condition may deteriorate, or when the patient’s condition
changes.
 Repeat assessment at least every 5 minutes for
priority patients and every 15 minutes for stable
patients.
 Primary assessment
 Relevant portion of the secondary assessment
 Vital signs
Patient Assessment – Vital Signs – Orthostatic BP
© 2013, 2010, 2002
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Skill Component
Teaching Points
 Evaluate results of reassessment and note any changes from
patient’s previous condition and vital signs
 Evaluating and comparing results assists in recognizing if the
patient is improving, responding to treatment or condition is
deteriorating.
**Manage patient condition as indicated.
PATIENT REPORT AND DOCUMENTATION
Skill Component
Teaching Points
 Important to document patient’s blood pressure in lying, sitting,
and standing positions (use stick figures).
§ Verbalize/Document:
 Blood pressure site used
 Blood pressure and pulse readings
(lying, sitting, standing)
Developed: 10/02
 Documentation must be on either the Los Angeles County EMS
Report form or departmental Patient Care Record form.
Revised 1/10, 1/13
Patient Assessment – Vital Signs – Orthostatic BP
© 2013, 2010, 2002
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PATIENT ASSESSMENT / VITAL SIGNS
ORTHOSTATIC
Supplemental Information
PURPOSE:
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To assess potential for hidden blood loss or decrease in circulating blood volume.
INDICATION:
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Suspicion of possible hypovolemia in patients who have a normal blood pressure and pulse rate.
CONTRAINDICATIONS:
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Hemorrhage/hypovolemia
Altered level of consciousness
Possible spinal injury
Signs of inadequate perfusion - weakness, dizziness, syncope
Signs of decreased circulating volume
Patients with irregular pulse or bradycardia
NOTES:
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Orthostatic vital signs are also known as postural vital signs or tilt test. This is a diagnostic procedure and not pertinent for
field assessment.
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Orthostatic vital signs are normally performed in 3 steps: lying  sitting  standing.
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A decrease of 10-20mm/Hg in either the systolic or diastolic pressure, or an increase of 10-20 beats/minute in the pulse rate
represents positive orthostatic changes. Physicians and text sources vary as to what values are considered positive;
therefore 10-20 range is given.
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Only one factor, a decrease of the systolic or diastolic blood pressure or an increase in the pulse, is required to determine a
positive orthostatic change.
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Patients with positive orthostatic changes should be suspected of having hidden blood loss and transported to the hospital
for further evaluation.
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Important to obtain a medical history as to medications because patients on calcium channel or beta blockers may not have
the ability to raise their pulse rate.
Patient Assessment – Vital Signs – Orthostatic BP
© 2013, 2010, 2002
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