When the emergency department encounters a patient with vertigo, the main points of diagnosis and treatment are analyzed in one article

*For medical professionals only

5 points to sort out the vertigo emergency points!

Vertigo is one of the common symptoms of emergency department, often requires emergency doctors to quickly determine the cause behind vertigo, carry out symptomatic treatment, and more importantly, identify the emergency treatment that should be carried out in time, so that patients can be treated

According to the classification of vestibular disease symptoms by the Classification Committee of the Bárány Association, the common symptoms in the emergency department are "vertigo" and some are "dizziness"

Figure 1: Symptoms associated with "halo" common in the emergency department, adapted from the ^{references [1].}

Emergency symptomatic treatment of drugs

Vertigo can cause severe discomfort and is often accompanied by symptoms

Figure 2: Anti-dizziness and antiemetic drugs commonly used in emergency ^{departments [1}].

Be sure to be clear about what types of vertigo need to be treated urgently so as not to miss the best time for
treatment.

The three major types of diseases require emergency departments to quickly determine the cause and treat them urgently
.

The details are as follows: First, central diseases
.

Cerebral infarction in acute cerebrovascular disease, if in the time window of thrombolysis, requires thrombolytic therapy; Timely based on endovascular interventional therapy in accordance with endovascular intervention
.

Cerebral hemorrhage in acute cerebrovascular disease requires blood pressure control, cranial pressure reduction, and surgery if necessary
.

Other types of central vertigo also include vestibular migraine, demyeling disease of the central nervous system, infections of the central nervous system, and mass lesions
of the fourth ventricle or cerebellum.
Second, diseases of the internal medicine system
.

For example, water-electrolyte imbalances need to be corrected; Endocrine diseases, such as hypoglycemia, require timely supplementation of sugars; In addition, including cardiovascular diseases, blood system diseases, autoimmune diseases, etc.
, while treating the symptoms, do not forget to consult with the relevant departments
.
Third, sudden deafness with vertigo, pay attention to hearing examination, give timely treatment, will help to save the patient's hearing
.
Here, we have also summarized the steps of emergency vertigo management for everyone, see Figure 3
.

It can be seen that the types of diseases in which emergency patients present as vertigo are complex and diverse, and the patient's condition changes
rapidly.

I hope that everyone will form a clear diagnostic idea, so that they can always remember the situations that need to be urgently dealt with and deal with
them calmly.

Figure 3: Highly summarizes the steps of emergency vertigo management

Don't forget to check professionally

Vertigo diseases are very complex, and the vertigo subspecialty requires well-established bedside vertigo-related physical examination training and thinking logic training
.

This edition of the guidelines features an appendix section that describes the bedside tests that should be performed when treating patients with vertigo in the emergency department, including: 1) spontaneous nystagmus, as shown in Figure 4
.
Figure 4: Difference between peripheral nystagmus and central nystagmus, adapted from reference ^[1]
2) HINTS examination (head pulse-nsokushwax-torsional deflection, head impulse, nystagmus, test of skew, HINTS), see Figure 5
.
Figure 5: HINTS check, adapted from reference ^[1]
3) a displacement test, including a Dix-Hallpike check and a Roll test check
.
4) Balance function check, commonly used tests include: Romberg and Mann test and gait assessment (linear walk test, in-situ step test, etc.

).
5) Ear examination
.
6) Tuning fork check, see Figure 6
.

Figure 6: Tuning fork examination results, adapted from the reference ^[1].

Complete vertigo diagnostic process

The guidelines give the procedure
for emergency vertigo examination and diagnosis in the main text.

Following the main text, the appendix section lists the emergency treatment process of non-isolated vertigo and the emergency treatment process
of isolated vertigo, respectively.

Here we will show three flow charts together (Figure 7-1 ~ Figure 7-3) for your convenience
.
Figure 7-1: Emergency vertigo examination and diagnosis process, adapted from ^{references[1]}
Figure 7-2: Non-isolated vertigo management procedures, adapted from ^{references[1]}
Figure 7-3: Treatment of isolated vertigo, adapted from ^{references [1].}

Vertigo is a common symptom of emergency department, symptomatic, cause treatment and referral specialist outpatient treatment, all need to be justified, "Vertigo Emergency Diagnosis and Treatment Guidelines (2021)" provides professional advice for the treatment of emergency vertigo, read the guidelines, have you gained anything?

References:

[1] Vertigo Professional Committee of Chinese Medical Education Association, Emergency Physician Branch of Chinese Medical Doctor Association.
Guidelines for the Diagnosis and Treatment of Vertigo Emergency (2021)[J].
Chinese Journal of Emergency Medicine,2021,30(4):402-406.
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The source of this article Medical Neurology Channel Author | HH This document reviews | Li Tuming Deputy Chief Physician Responsible EditorMr.
Lu Li

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