• Remember that you can also connect with RNZCUC Registrars via our Facebook group
  • The Registrar Sub-Committee is looking for members for 2026.
  • If you are interested in becoming involved with the Registrar Subcommittee, please e-mail: regsc@rnzcuc.org.nz

🥳 Social Calendar (Upcoming Events)

  • Informal Social Catch-Up for RNZCUC Registrars
    • Date: Friday, 3rd October
    • Time: 7:00-9:00 pm
    • Location: The Garden Shed, 470 Mt Eden Road, Auckland
    • Details: Fellows welcome! Share some food and drink and socialise with us. This is a great opportunity to connect before exams (written and OSCE).
    • Click here to RSVP 

 📚 Informal trainee-led trainings:

  • Upcoming OSCE Teaching Workshop
    • Date: September – October 2025
    • Time: 6-8 pm
    • Facilitator: Dr. Pauline Teong
      • With UCPEX coming up, Dr. Pauline Teong has kindly offered to hold some teaching sessions that focus on exam preparation.
      • Dr. Teong has extensive experience with four major board exams, including:
        • RNZCUC Urgent Care OSCE
        • General Surgery MRCS Edinburgh
        • Emergency Medicine MRCS Edinburgh
        • GPEP exams (more recently)
      • These sessions will not provide specific exam hints but will focus on general strategies for approaching exams effectively.
      • Dr. Teong will aim to create groups of similar experience levels with a maximum of 3-5 people per group.
      • These teaching sessions were incredibly popular and helpful last year, so remember to sign up ASAP!
    • Click here to Register
  • Upcoming Zoom Sessions:
    • ORL Emergencies and Vascular Emergencies in Urgent Care
      • Date: September 16th, 2025
      • Time: 7 pm
      • Facilitator: Associate Professor Murali Mahadevan (ENT) and Dr. Giri Mahadevan (Vascular Surgery)
      • Zoom link
        • Meeting ID: 845 8745 7259 
        • Passcode: 508390
    • Toxicology for Urgent Care
      • Date: October 22nd, 2025
      • Time: 7 pm
      • Facilitator: Dr. Samantha Scahill (Urgent Care)
      • Zoom Link
        • Meeting ID: 853 4805 8993
        • 553005

Remember: All of the recordings of these past sessions are on the RNZCUC Registrars Facebook Group

🎧 Recent ‘Urgent Bites’ by Dr Guy Melrose

✨ Medical Marvel

Postural Hypotension

  • Definitions:
    • A drop in BP when going from lying or sitting to standing, which is accompanied by symptoms.
    • The BMJ gives 8 different definitions from 8 different guidelines.
    • In practice, most of us will follow the recommendation in the NICE hypertension guidance:
      • A drop of ≥20mmHg in SYSTOLIC BP on standing for 1 minute (from sitting/lying)

To look for this:

  • Take the blood pressure sitting or lying. Stand the patient up and check BP after they have been standing for at least 1 minute
  • However, if there has been a loss of consciousness, you might want to follow the NICE guidance on transient loss of consciousness, which recommends:
    • Measure BP while lying down, then stand and do repeated BP readings for 3 minutes. Unfortunately, NICE does not specify what a ‘significant’ BP drop is in the context of transient loss of consciousness

The BMJ article also stresses the importance of measuring the pulse as well as the BP – something not mentioned in the NICE hypertension guidance. More on this below

Who does postural hypotension matter?

  • Puts people at increased risk of falls
  • Impairs quality of life
  • Increases the risk of CVD (coronary artery disease, heart failure, stroke, AF), depression, dementia, and death

Presenting symptoms:

  • Symptoms commonly occur first thing in the morning ion getting out of bed, but may also occur during the day
  • Establish whether this was a single isolated episode or a regular issue
Symptom Comparison
COMMON SYMPTOMS LESS COMMON and LESS SPECIFIC SYMPTOMS
  • Dizziness
    • – lightheadedness (feeling faint)
    • – rotational dizziness
  • Falls
  • Transient loss of consciousness
  • Visual sx: blurred vision/visual field defects
  • Cognitive sx: difficult concentrating, cognitive slowing
  • Weakness or fatigue
  • Short of breath, chest pain, backache, pain lower limb
  • Coat hangar headache – shoulder, neck, suboccipital

NOTE: ‘orthostatic’ hypotension that does not correct on lying flat is NOT orthostatic hypotension

Who might have it?

  • Those with classical symptoms
  • NICE guidance recommends looking for postural hypotension in patients with hypertension with
    • Age ≥80 (prevalence may be as high as 25% in those over 85)
    • Type 2 diabetes
  • Consider those with autonomic dysfunction eg. Parkinson’s disease or autonomic neuropathies

Causes

  • Try to establish the cause. Some people will have several causes.
  • Causes are often separated into neurogenic (neuropathic) and non-neurogenic.

Postural hypotension with an increase in heart rate <15bpm suggests a neuropathic causes (defective adrenergic vasoconstriction/autonomic failure)

Tip: Dodgy nerves don’t increase heart rate

Causes Table
NEUROPATHIC CAUSES OTHER CAUSES DRUG CAUSES
  • Neurodegenerative
    • Eg. Parkinson’s disease
  • Peripheral neuropathy
    • – Diabetes
    • – B12 deficiency
    • – Renal failure
    • – Rheumatological
    • – Autoimmune
    • – Amyloidosis
    • – Paraneoplastic states
  • Physical deconditioning
  • Ageing
  • Alcohol
  • Adrenal insufficiency
  • Idiopathic
  • Volume depletion
    • – Dehydration
    • – Anaemia
    • – Haemorrhage
  • Cardiovascular
    • – Hypertension
    • – Heart failure
    • – Aortic stenosis
    • – Atherosclerosis, vascular stiffness
    • – Arrythmias
  • Cardiovascular
    • – Antihypertensives
    • – Nitrates
    • – Diuretics
    • – Alpha-blockers
    • – Beta-blockers
  • Psychiatric
    • – SSRI
    • – Tricyclics
    • – Antipsychotics

Differential Diagnosis

  • Post-prandial hypotension
  • Vasovagal syncope – usually younger population. Look for the 3Ps
    • Provoking factors, eg, a Hot room, having blood taken
    • Posture, eg, standing still
    • Prodrome – a building sensation that they are going to pass out
  • Carotid sinus syndrome
    • Can cause syncope or near syncope
    • More common in older people
    • Difficult to distinguish from postural hypotension. Tilt table testing may assist in differentiating

Investigations

  • Examination: targeted to look for probable causes
  • Bloods
    • FBC (anaemia), renal function, Hb1Ac (diabetes), B12 (peripheral neuropathy)
  • ECG if arrhythmia suspected
  • Echocardiogram if a structural heart problem is suspected eg, murmur