REBEL Core Cast – Basics of EM – Dizziness

Take Home Points

  • Key point is to discern between central and peripheral causes – become familiar with the nuances of one and concentrate on that
  • Assume central and convince yourself its peripheral in nature, if at the end of the evaluation, you can’t do that, assume a central cause and do a work-up
  • Using timing and characteristics to help you – intensity, inducible, fatiguable, constant or not, associated symptoms
  • Always do a full neuro exam – finger to nose, heel to shin, and ambulate these patients – if they can’t walk, DO NOT DISCHARGE
  • Perform bedside tests to help in your decision – Dix-Halpike, Romberg – know that we are not good at performing the HiNTS exam, so don’t rely on it
  • MRI/MRA is the diagnostic study of choice if you thinks its central – do not hesitate to get this test if you think its a central cause
  • Perform the Epley Maneuver with with the patient if you identify a BPPV – but only after you give medication – tell them to repeat the exam and give instructions on how to do so

REBEL Core Cast – Basics of EM – Dizziness

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Anand Swaminathan, MD
Twitter: @EMSwami

Post Peer Reviewed By: Anand Swaminathan, MD (Twitter: @EMSwami)

Cite this article as: Ellsworth Wright, "REBEL Core Cast – Basics of EM – Dizziness", REBEL EM blog, June 1, 2022. Available at:
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Ellsworth Wright

Emergency Physician at St. Joseph's Regional Medical Center

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