Once you spend enough time with inpatient care, you will realize how every aspect of your patient’s bathroom tries to get them to keel over. Tripping over IV lines & poles on the way in, micturition syncope while peeing, orthostatic syncope while getting off the commode & slipping off the wet floor with a concussion are a dime a dozen. And if they somehow avoid all that, their warm shower awaits like a mad scientist rubbing hands together! The prospect of passing out while showering & waking up butt naked to staff carrying me back is terrifying to me 😬😲
Hot showers make our body redirect blood supply to our skin to get rid of excess heat by dilating cutaneous blood vessels. Skin being our largest organ, a sudden dilation of all those blood vessels can be significant enough to drop blood pressures, especially if already low on BP or blood volume. Doesnt help that recent blood loss makes a person feel colder and more desirous of hotter shower.
Learning Tip:
Shower syncopes are potentially nasty with risk of head injury & fractures but avoidable. Be aware of the risk in advance to inpatients with acute GI and other bleeds, any recent surgery, low BP, recent syncope, dizzy to begin with & those pregnant. Take the following measures to avoid shower syncopes via ordered instructions to patient’s nurse/staff and advising your patient on rounds:
- Always have them seated for a warm shower, get up slowly when done
- Keep showers just warm enough, avoid excessively hot
- Keep it short, longer warm showers poser higher syncope risk
- Check on them after 5-10 minutes
- Walk them back to bed, passing out can still happen immediately after
