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Points and Pearls Excerpt
Although dizziness is a common complaint in the ED, an exact cause is often unclear.
Use a “timing-and-triggers” approach to the diagnosis of patients with dizziness; the classic “symptom-quality” approach (“What do you mean, ‘dizzy’?) should be avoided.
The timings-and-triggers approach to dizziness sorts patients into one of 3 groups (1) acute vestibular syndrome (AVS), (2) the spontaneous episodic vestibular syndrome (s-EVS), and (3) the triggered episodic vestibular syndrome (t-EVS), each of which is tightly associated with a specific differential diagnosis.
Brief episodes of dizziness that wake a patient up from sleep are nearly always BPPV.
Petra Duran-Gehring, MD, RDMS, FACEP; Christopher Lewandowski, MD; Vasisht Srinivasan, MD
December 1, 2019
CME Expiration Date
December 1, 2022
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 2 Stroke CME credits
Upon completion of this article, you should be able to:
Explain the timing-and-triggers approach to the diagnosis of patients with dizziness
Describe the differential diagnosis of each of the vestibular syndromes
Recognize a posterior circulation transient ischemic attack in patients presenting with transient episodes of dizziness
Utilize bedside physical examination maneuvers to diagnose and treat acute dizziness, when appropriate.
Date of Original Release: December 1, 2019. Date of most recent review: November 10, 2019. Termination date: December 1, 2022.
Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME.
Credit Designation: EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
ACEP Accreditation: Emergency Medicine Practice is approved by the American College of Emergency Physicians for 48 hours of ACEP Category I credit per annual subscription.
AAFP Accreditation: This Enduring Material activity, Emergency Medicine Practice, has been reviewed and is acceptable for credit by the American Academy of Family Physicians. Term of approval begins 07/01/2019. Term of approval is for one year from this date. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Approved for 4 AAFP Prescribed credits.
AOA Accreditation: Emergency Medicine Practice is eligible for 4 Category 2-A or 2-B credit hours per issue by the American Osteopathic Association.
Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 2 Stroke CME credits.
Needs Assessment: The need for this educational activity was determined by a survey of medical staff, including the editorial board of this publication; review of morbidity and mortality data from the CDC, AHA, NCHS, and ACEP; and evaluation of prior activities for emergency physicians.
Target Audience: This enduring material is designed for emergency medicine physicians, physician assistants, nurse practitioners, and residents.
Goals: Upon completion of this activity, you should be able to: (1) demonstrate medical decision-making based on the strongest clinical evidence; (2) cost-effectively diagnose and treat the most critical presentations; and (3) describe the most common medicolegal pitfalls for each topic covered.
Discussion of Investigational Information: As part of the journal, faculty may be presenting investigational information about pharmaceutical products that is outside Food and Drug Administration–approved labeling. Information presented as part of this activity is intended solely as continuing medical education and is not intended to promote off-label use of any pharmaceutical product.
Faculty Disclosures: It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. In compliance with all ACCME Essentials, Standards, and Guidelines, all faculty for this CME activity were asked to complete a full disclosure statement. The information received is as follows: Dr. Edlow, Dr. Duran-Gehring, Dr. Srinivasan, Dr. Mishler, Dr. Toscano, Dr. Jagoda, and their related parties report no relevant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation. Dr. Lewandowski reported a relationship as consultant/advisor to Shire/Takeda.
Commercial Support: This issue of Emergency Medicine Practice did not receive any commercial support.
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