Description: the preliminary workup assessment and plan block for dizziness and presyncope.
Dizziness smart phrase:
Dizziness/Presyncope: DDx includes orthostatic hypotension, cardiac source, vestibular disorders, , anxiety/depression, medication induced. Evaluation plan:
Orthostatic hypotension
– Check orthostatic vital signs; IVF if orthostatic
– CBC/BMG
– Daily weights
Cardiac source: History of ***arrythmia ***aortic stenosis, and physical exam shows ***irregularly irregular rhythm, ***bradycardia, ***tachycardia, ***murmur suggesting cardiac source to pre-syncope
– ECG
– Telemetry
– Echocardiogram
Migraine: History of ***headache, photophobia, visual aura or changes, and previous migraines suggest migraine possible source.
CNS disorder: History of ***atrial fibrillation (CHADS2 score) on***not on coumadin, ***previous CVA, ***seizure disorder, with neuro exam findings of ***, suggest a neuro origin to dizziness.
– EEG
– Head CT
– If Head CT negative for bleed, permissive hypertension, daily aspirin
– Frequent neuro checks
Vestibular disorders: Vertigo (sensation of movement while sationary) suggests of vestibular source. History of ***brief (less than 30 s) dizziness with head movement in one direction and no tinnitus consistent with BPPV ***prolonged (longer than 30 s) dizziness, tinnitus, and nausea that has been happening for more than 2 weeks consistent with Meniere’s disease ***prolonged (longer than 30 s) dizziness for less than 2 weeks and a recent URI consistent with viral vestibulitis or labyrinthitis ***worsening dizziness, hearing loss, tinitus, papilledema, other cranial nerve deficits (esp CN 7, 9/10) concerning for vestibular schwannoma (AKA acoustic neuroma).
– Otoscopic exam shows ***
– Ophthalmoscopic exam shows ***yes/no papilledema
– ***Dix-Hallpike test for BPV
– ***If hearing loss or tinnitus: Audiology testing
– ***If concern for schwannoma or Meniere’s disease: Brain MRI with thin slices through posterior fossa
Anxiety/depression: History of *** suggests anxiety/depression as a contributing factor.
Medication: Recent medication addition/change of ***
