Professional Documents
Culture Documents
Perpective
7.5 mil/year in ambulatory care settings
Dizziness In The ER
Pts difficult to interview, time consuming
Evaluation
Often difficult & time consuming commonly referred to
medical specialists
Neurologist, Otolaryngologist, Ophthalmologist do play
important role in the patient evaluation
But.... In reality, most of the pts have an organic basis
for symptoms that can be successfully identified and
treated good history and focal PE in the primary care
setting
Goal of the primary clinician
Recognize which pts need inpatient management or
emergency intervention
Evaluation
true vertigo??
Decide whether it is central or peripheral
Is it
VERTIGO
Vestibuler
Non-Vestibuler
Rasa berputar
(true vertigo)
Rasa melayang,
goyang, sempoyongan
Episodik
Kontinyu
Mual/Muntah
(++)
(+/-)
Gangguan
Pendengaran
(+/-)
(-)
Gerakan Kepala
(-)
Sistem Vestibular
Sistem Visual,
somatosensorik
(proprioseptif)
Sifat Vertigo
Sifat Serangan
Gerakan Pencetus
Situasi Pencetus
Letak Lesi
Vertigo Vestibuler
Perifer
Sentral
Mendadak
Lebih lambat
Berat
Ringan
Pengaruh Gerakan
Kepala
(+)
(-)
Gejala Otonom
(++)
(-)
Gangguan Pendengaran
(+)
(-)
(-)
(+)
Bangkitan Vertigo
Intensitas
In the
ER
Acute severe
dizziness
Recurrent
attack of
dizziness
Recurrent
positional
dizziness
Spontaneous Nystagmus
Unidirectional nystagmus
Head-Thrust Test
Positive with movements
toward abnormal side
Stroke
Spontaneous Nystagmus
Bidirectional gaze-evoked,
Pure torsional, Spontaneous
vertical nystagmus
Head-Thrust Test
Normal
BPPV
Episodes < 1 min
BPPV
Ca carbonate debris dislodge from otoconial membrane in
fullness
Nystagmus may not follow the rule of nystagmus VN but red flag
for CNS nystagmus apply
Head thrust generally normal since N.VIII is intact
Symptomatic Treatment
Severe nausea & vomiting IV fluids during ER stay
Summary
`Summary
The most effective way to rule out a serious case is to