Stop Spinning Your Wheels: Getting Dizzy Right in the ED

Do you let out an audible groan when your track board lights up with the chief complaint of “Dizziness”? It’s time to turn that despair into action–because the stakes are high and the pitfalls are many. This could be a stroke!

In this session, we will highlight common diagnostic pitfalls in the evaluation of the acutely dizzy patient, focusing on the “timing and triggers” approach to vertigo to identify those patients most at risk for central causes of vertigo. We will discuss an evidence-based approach to vertigo, supported and outlined in the GRACE-3 clinical practice guidelines. We will emphasize the neurologic exam, with a review of the HINTS exam and how to apply it at the bedside. Finally, we will review key recommendations from GRACE-3, specifically as they apply to patients presenting with acute vestibular syndrome, including the limitations of imaging and the importance of incorporating the physical exam into our diagnostic schema.