EMCrit 362 - Jonathan Edlow, Lead Author of GRACE-3, on Dizziness
Nov 17, 2023
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Jonathan Edlow, Lead Author of GRACE-3, discusses strategies for managing dizziness in emergency medicine, emphasizing the importance of physical examination over imaging. The conversation highlights the challenges in differentiating between central and peripheral acute vestibular syndromes, exploring the efficiency of the HINDS exam for stroke patients, and the role of physical therapists in managing vestibular issues. Ongoing studies on dizziness and eye lenses are also highlighted.
Differentiating between vestibular syndromes aids in appropriate management of dizziness patients.
Involving physical therapists with expertise in vestibular conditions can expedite patient care and allow for timely interventions.
Deep dives
Importance of Rapid Assessment in Dizziness Cases
In emergency departments, prompt assessment of dizziness patients is crucial. Differentiating between various vestibular syndromes, like acute, spontaneous, and triggered, aids in appropriate management. The use of standing protocols, including the head impulse test and nystagmus testing, simplifies the process for emergency physicians. The protocol assists in identifying common conditions like benign paroxysmal positional vertigo (BPPV) and posterior circulation TIAs.
Consideration of Stroke Teams and Thrombolysis
In cases where dizziness symptoms hint at a central nervous system issue, involving stroke teams becomes essential. Differentiation between central and peripheral causes through tests like the HINTS exam is vital. Rapid neuro checks at triage can identify potential stroke candidates for urgent treatment. Considerations for thrombolysis depend on the facility's protocols and the philosophy of the stroke neurology team.
Training Regimen for Emergency Physicians on Vestibular Conditions
Training programs focused on vestibular conditions, such as BPPV and neuro checks, can benefit emergency physicians. While specialized courses may exist, the feasibility and efficacy of shorter, more focused training remain uncertain. Emphasizing the importance of understanding migraine and peripheral vestibular pathologies can enhance diagnostic accuracy in the emergency department.
Role of Physical Therapists in Dizziness Management
In the context of dizziness, involving physical therapists with expertise in vestibular conditions can expedite patient care. Physical therapists proficient in HINTS and BPPV maneuvers can offer quick and accurate diagnoses. Their specialized training allows for timely interventions and potentially quicker patient follow-ups compared to traditional referral pathways.