dizziness and ALS criteria

N

nymedic9999

Forum Probie
Messages
21
Reaction score
1
Points
3
When can a dizzy patient go bls and when should one go als?
 
Depends on the assessment. You've provided one symptom. Can you elaborate a bit about the case you're discussing?
 
Kid on a merry-go-round?
 
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.
 
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.
 
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.
 
+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.
 
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.
 
Als

[YOUTUBE]http://www.youtube.com/watch?v=Df4kS1hwJfo[/YOUTUBE]
 
Not BLS, but CPS

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

(Insert ad for "nanny-cams").
 
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.
 
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.
 
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]"
 
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.
 
Last edited by a moderator:
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.
Click to expand...


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

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.
 
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.
Click to expand...


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.
 
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.
 
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:
 
You must log in or register to reply here.
Back
Top