Orthostatic hypotension in SCI

1. Why does reflex depression of BP occur in SCI? What levels are at risk for this and why?
2. What is the response in a SCI patient to being placed upright?
3. How is orthostatic hypotension treated in SCI patients?

Answers:
1. Low BP is caused by lack of sympathetic outflow (which would usually cause vasoconstriction) when patient is >60 degrees upright. This occurs at lesions T6 or above, due to the heart and blood vessels being supplied by T1-T7.
2. Hypotension and tachycardia (due to inhibition of parasympathetics).
3. Repositioning (Trendelenberg, tilt table), elastic stockings, abdominal binder, ACE wrap LEs, salt tabs, florinef, ephidrine, fluids.