Vertigo
Vertigo
Stable patients with symptoms consistent with peripheral vertigo
Normal cranial nerve and cerebellar exam
No evidence of acute intracranial processes on CT head, if obtained.
Patient demonstrates symptoms concerning for a central cause of vertigo including acute hearing loss, double vision, ataxia, neurological deficits
Emergency Department provider has high clinical suspicion of central vertigo or stroke
Patient has severe headache or head trauma associated with vertigo
Cardiac monitoring
Neurological checks every four hours
Medication
If symptoms consistent with vestibular neuronitis:
Antiemetics (Compazine, Phenergan, Reglan, Zofran)
Prednisone with taper
If symptoms consistent with benign paroxysmal positional vertigo (BPPV):
Antihistamines (Meclizine, Dramamine)
Benzodiazepines (Diazepam, Lorazepam)
Antiemetics (Droperidol, Prochlorperazine, Promethazine, Metoclopramide, Ondansetron)
If patient demonstrates signs and symptoms concerning for central cause of vertigo during admission:
Cardiac monitoring
Neuro checks q 2 hours x 12 hours then q 4 hours for total of 24 hours
Obtain further imaging CTA head and Neck (if not already obtained in ED), MRI brain
Physical Therapy Consult for Vestibular Rehab / Otolith Repositioning. Availability of Vestibular trained PT is variable. Call lead PT x85757 (8a-4p) to inquire.
Disposition
Vertigo and associated symptoms improved with medications.
Able to take PO medications
Neuroimaging without significant abnormalities, if obtained.
Stable vital signs
Unstable vital signs or worsening clinical condition
Significant lab or imaging abnormalities
Patient unable to take PO medications or able to safely care for self in home environment.
Learning Links: