# vertigo?



## WVEmt (Dec 3, 2010)

911 to a 60 y/o m c/o nausea and dizziness. 

upon arrival pt is found in garage sitting in a chair. pt is diaphoretic and pale. denies any chest pain and sob. says he had a similar episode 2 weeks ago and was diagnosed with vertigo. pt states he took a hydrocodone shortly before onset. 

pts family produces meds. metocolopramide, lvalium, and one other i cant remember off the top of my head. know that its not cardiac. pts family had pill bottles in a bag. 

pt denies any history except vertigo and kidney stones. 

vitals: pulse 65 irregular, bp 122/87, spo2 93 on room air, resps 20, glucose 164, perl, gcs 456.

pt placed on o2 4lpm. spo2 up to 98. im thinking cardiac related and being a bls unit call for a medic. run a 12 lead and it shows a lbbb. asked again pt denies and cardiac hx. 

medic arrives and does an assessment and new 12 lead. same results. pt states he is feeling better and medic clears it a bls run. 

any thoughts would be appreciated


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## reaper86 (Dec 3, 2010)

Ok, have a couple of questions for you.  How long has he been taking these medications?  More specifically, has he been prescribed any of these medications in the past 2 weeks?  Just to be sure, is Ivalium aka Valium?  Also, what was the patient doing right before the symptoms started? 

The Metoclopramide can cause dizziness, as can Valium.  The Oxycodone can cause the nausea as well as the dizziness.


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## EMS49393 (Dec 4, 2010)

My only thought is that I wouldn't have turfed it to BLS.

60 year old patient with vague nausea, dizziness, vertigo complaints always give me a red flag warning.

Besides, he has a LBBB, and if he has no cardiac history, and no previous ECG for comparison, he is now a cardiac patient, period.


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## Smash (Dec 4, 2010)

EMS49393 said:


> Besides, he has a LBBB, and if he has no cardiac history, and no previous ECG for comparison, he is now a cardiac patient, period.



Plain old LBBB, new or old, does not rule in for infarct.  LBBB fulfilling any Sgarbossa criteria (modified) does.

I'd be more concerned with a neuro event.  Vertigo is symptom, not a diagnosis (in the field that is) and can be a tricky thing to pin down - is it a simple perihperal vertigo or something more sinister like a brainstem infarct?  Treat his symptoms with some prochlorperazine or something similar and take him to a hospital equipped to investigate him.


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