# dizziness and ALS criteria



## nymedic9999 (Nov 23, 2013)

When can a dizzy patient go bls and when should one go als?


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## abckidsmom (Nov 23, 2013)

Depends on the assessment. You've provided one symptom.  Can you elaborate a bit about the case you're discussing?


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## mycrofft (Nov 23, 2013)

Kid on a merry-go-round?


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## AeroClinician (Nov 23, 2013)

History of, and diagnosed with inner ear problems with non-compliance with meclizine. That kind of dizziness, can be BLSed provided the rest of the exam proved to be WNL.


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## medicsb (Nov 23, 2013)

Generally... If HR is not too fast or too slow, BP too high or too low, hypoxia, or hypoglycemia.  In high-risk populations with higher rates of atypical presentations, you could consider a 12-lead to look for STEMI.


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## Brandon O (Nov 24, 2013)

Nobody's dizzy. Unpack it into vertigo (room's spinning) or lightheaded (dark and fuzzy). You're probably all set on vertigo (slim chance on a cerebellar stroke, but the medics aren't gonna do anything about that either). Lightheaded, use your assessment to decide if it's cardiac (probably), then decide if you're worried (MI, arrhythmia). If so, call for help and look for the dude with a squiggly-line box.

Generally if they got lightheaded, maybe passed out, but now they feel okay, I am not too worried (unless you're scared of arrhythmias coming and going; I get especially spooked by young athletes who crump during exercise). Significant, persistent, otherwise unexplained lightheadedness while they're sitting on your stretcher is not a good thing.


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## Ewok Jerky (Nov 24, 2013)

+1 to the above posters.

"dizziness" is a vague symptom that could be further defined as vertigo. lightheadedness, or disequilibrium.  The most concerning for pre-hospital providers cardiovascular/hypovolemia causing lightheadedness and strokes causing disequilibrium.  Lots of ear issues can cause vertigo and disequilibrium.  If the Hx can rule out major life threats/medic-treatable causes then the Pt can go BLS.  A 12-lead would be nice as well as full cardiac and neuro assessment.


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## medicsb (Nov 24, 2013)

Having now done 3 moths of EM, I feel like I can say that "dizziness" is one of the worst chief complaints, even after teasing apart light-headedness from vertigo.  It may necessitate an extensive work-up.  Usually, nothing is found wrong and you're left with no real explanation.


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## mycrofft (Nov 25, 2013)

*Als*

[YOUTUBE]http://www.youtube.com/watch?v=Df4kS1hwJfo[/YOUTUBE]


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## mycrofft (Nov 25, 2013)

*Not BLS, but CPS*

[YOUTUBE]http://www.youtube.com/watch?v=K-iLwC8nh7A[/YOUTUBE]

(Insert ad for "nanny-cams").


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## unleashedfury (Nov 25, 2013)

mycrofft said:


> [YOUTUBE]http://www.youtube.com/watch?v=K-iLwC8nh7A[/YOUTUBE]
> 
> (Insert ad for "nanny-cams").



I actually thought it was a preview for the upcoming Teen Mom season


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## EMT856 (Dec 13, 2013)

You are the EMT. It is up to you. If you dont feel like they are ALS level patients based on your experience, then recall ALS if you are comfortable doing that. We all have our own way of doing things, but personally I end up recalling ALS 80% of they time that they are dispatched.


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## Glucatron (Dec 13, 2013)

If they are dizzy my medic would probably grab a 4 or 12 lead and (obviously a set of vitals). What were they doing when the dizziness started? Describe it, if they can. Have they hit their head? Drugs/ETOH? Have they lost consciousness at all? Any other complaints? If there is any sign that it may be cardiac/SOB in nature it's ALS. That's how my partner and I figure it out.


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## NPO (Jan 28, 2014)

Dizziness isn't on our list of ALS criteria specifically but may fall under other categories depending on other signs and symptoms. 

At that point my protocol states:

"If EMT personnel encounter a life threatening condition, they should exercise their clinical judgment as to whether it is in the patients best interest to transport the patient prior to the arrival of an ALS unit if their ETA is greater than the ETA to the nearest [ER]"


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## Rialaigh (Jan 28, 2014)

Not to say it never happens but in 3 and half years of working in a hospital system (a chunk of that spent in the ER) We never had a patient come in complaining of only dizzyness that actually showed anything acute on a 12 lead. We had plenty who were bradycardic which could be determine by simply taking a pulse...we had quite a few who were hypotensive, but I never saw a patient complaining of that who had some acute changes on a 12 lead. 

I know it can be cardiac caused, but many of the cardiac causes will be accompanied by bradycardia (heart blocks, etc) or Tachycardia (SVT, Vtach with a pulse) and can be ruled in without actually doing a 12 lead just by a check of vitals.  


If the vitals are normal and the patient doesn't have some other symptom (uncontrolled vomiting) and the patient doesn't look like death is knocking, BLS all the way.


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## Handsome Robb (Jan 28, 2014)

AeroClinician said:


> History of, and diagnosed with inner ear problems with non-compliance with meclizine. That kind of dizziness, can be BLSed provided the rest of the exam proved to be WNL.




I had this call, almost gave it to my intermediate but my spidey sense were tingling. Massive inferior MI.


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## Wheel (Jan 28, 2014)

Robb said:


> I had this call, almost gave it to my intermediate but my spidey sense were tingling. Massive inferior MI.



Yeah, I think this would depend on the age of the patient and other risk factors. If the patient is 30, with no other medical problems? BLS. If the patient is 60 with HTN, or diabetes, or CAD, or stroke history, or any number of things, then they're getting a 12 Lead.


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## Handsome Robb (Jan 28, 2014)

Wheel said:


> Yeah, I think this would depend on the age of the patient and other risk factors. If the patient is 30, with no other medical problems? BLS. If the patient is 60 with HTN, or diabetes, or CAD, or stroke history, or any number of things, then they're getting a 12 Lead.




He was 59, no other history besides vertigo, no allergies, only med was meclizine. Super healthy looking guy.

Scared the bajeebers out if me when I turned on the 12-lead on the Philips. Didn't even need to print it, I did obviously, but still lol.


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## TheLocalMedic (Jan 28, 2014)

God, I hate complaints of dizziness.  I say just send them ALS, there's so much to do, check and rule out before making it BLS that you'd end up sitting on scene for a fairly long time before determining that it truly can be kicked down.  Might as well just hit the road ALS and do all the exam stuff en route.


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## mycrofft (Jan 28, 2014)

I love the "noncompliant with meclizine" note. Meclazine doesn't fix anything, it suppresses vertigo. 

"What , you have a cholestotoma in your vestibular apparatus? Here, take two of these  twice a day (or put this patch behind your ear) and come back when the tumor has destroyed your hearing and isn't controlled by drugs anymore, meaning your vestibular apparatus is gone".:wacko:


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## Wheel (Jan 29, 2014)

Robb said:


> He was 59, no other history besides vertigo, no allergies, only med was meclizine. Super healthy looking guy.
> 
> Scared the bajeebers out if me when I turned on the 12-lead on the Philips. Didn't even need to print it, I did obviously, but still lol.



Yeah, his age alone probably would have gotten him a 12-lead with me.


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## TheLocalMedic (Jan 30, 2014)

This thread was awfully timely.  Right after I griped about hating dizziness complaints I got one today.  Got the full workup and didn't find anything, although it was interesting to watch the woman grip the rails of the gurney for dear life, saying that she felt like the room was spinning.


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