From the Guidelines
Orthostatic hypotension is a condition that requires immediate attention from paramedics, and the primary treatment involves positioning the patient in a supine position with legs elevated and administering fluids, with the goal of restoring adequate cerebral perfusion and preventing complications. As defined by recent studies 1, orthostatic hypotension is characterized by a sudden drop in blood pressure when a person changes position, causing symptoms like dizziness and fainting. The therapeutic goal is to minimize postural symptoms rather than to restore normotension.
Key Interventions
- Positioning: placing the patient in a supine position with legs elevated to improve venous return to the heart
- Fluid administration: providing oral fluids if the patient is conscious and able to swallow, or establishing intravenous access and administering isotonic fluids such as 0.9% Normal Saline for more severe cases
- Addressing underlying causes: identifying and managing any underlying conditions, such as dehydration, blood loss, or medication effects, that may be contributing to the orthostatic hypotension
- Monitoring vital signs: continuously monitoring blood pressure, heart rate, and oxygen saturation to assess the patient's response to treatment
Additional Considerations
- Oxygen therapy: providing oxygen if the patient shows signs of hypoxia
- Contacting medical control: seeking further guidance if symptoms persist despite initial interventions, especially in patients taking medications known to cause orthostatic hypotension
- Nonpharmacologic measures: encouraging physical activity and exercise to avoid deconditioning, and promoting volume repletion with fluids and salt, as recommended by studies 1
- Pharmacologic measures: considering the use of medications such as midodrine and droxidopa, which are approved by the FDA for the treatment of orthostatic hypotension, as mentioned in studies 1
From the FDA Drug Label
Midodrine hydrochloride tablets are indicated for the treatment of symptomatic orthostatic hypotension (OH) Because midodrine hydrochloride tablets can cause marked elevation of supine blood pressure (BP>200 mmHg systolic), it should be used in patients whose lives are considerably impaired despite standard clinical care, including non-pharmacologic treatment (such as support stockings), fluid expansion, and lifestyle alterations
Orthostatic Hypotension is a condition where a patient's blood pressure drops when standing up, causing symptoms such as dizziness and lightheadedness. As paramedics, the treatment for orthostatic hypotension includes:
- Non-pharmacologic treatments such as:
- Fluid expansion
- Lifestyle alterations
- Support stockings
- Pharmacologic treatment with midodrine, which can help increase blood pressure in patients with orthostatic hypotension 2 It is essential to monitor the patient's blood pressure and adjust the treatment plan accordingly to avoid supine hypertension. In the field, paramedics should follow local protocols and consult with medical direction when treating patients with orthostatic hypotension.
From the Research
Definition and Symptoms of Orthostatic Hypotension
- Orthostatic hypotension is defined as a decrease in blood pressure of 20 mm Hg or more systolic or 10 mm Hg or more diastolic within three minutes of standing from the supine position or on assuming a head-up position of at least 60 degrees during tilt table testing 3.
- Symptoms of orthostatic hypotension include headache, lightheadedness, shoulder and neck pain (coat hanger syndrome), visual disturbances, dyspnea, and chest pain 3.
Treatment of Orthostatic Hypotension
- Treatment goals for orthostatic hypotension are reducing symptoms and improving quality of life 3.
- Initial treatment focuses on the underlying cause and adjusting potentially causative medications 3.
- Nonpharmacologic strategies include dietary modifications, compression garments, physical maneuvers, and avoiding environments that exacerbate symptoms 3, 4.
- First-line medications include midodrine and droxidopa 3.
- Midodrine is a peripheral alpha-adrenergic agonist that increases standing blood pressure and improves symptoms of orthostatic hypotension without associated cardiac stimulation 5, 6, 7.
Paramedic Treatment of Orthostatic Hypotension
- As paramedics, the treatment of orthostatic hypotension would involve identifying and managing the underlying cause, as well as providing supportive care to alleviate symptoms 3.
- This may include administering midodrine or other medications as prescribed by a physician, as well as using nonpharmacologic strategies such as elevating the patient's legs and providing fluids 5, 6, 3.
- It is essential to monitor the patient's blood pressure and adjust treatment accordingly to avoid excessive supine hypertension 4.