State of Wisconsin Emergency Medical Services

Sample Medical Guidelines Vertigo

Note:
Vertigo ranges from mild to severe severe enough to become incapacitating and require EMS help. Most patients complain about dizziness. The provider must differentiate the spinning or falling feeling associated ith vertigo from lightheadedness! hich is another common reason for patients to complain of dizziness! but should not be treated according to this protocol. Vertigo can occasionall" be a s"mptom of stro#e! but is most commonl" a disturbance of spatial orientation and motion sense in the inner ear. Vertigo is commonl" associated ith nausea and vomiting

Priorities
$hief $omplaint &'()ST *ssociated S"mptoms+ 'ertinent ,egative S*M'1E 3nitial E-am %etailed 5ocused E-am 7oals of Therap" Monitoring

Assessment Findings
%izziness! Spinning or falling sensation %etermine onset and duration. 'rovo#ed b" changing position or turning head. %izziness! nausea! vomiting! ata-ia! and falls . ith or ithout in/ur"0 E-posure to #no n allergen. 2istor" of $V*+T3*. *4$s and correct an" life threats General Appearance: E"es closed! 'ale Neuro: *1&$6! 5ocal deficits! 'upils Eyes: ,"stagmus ith lateral gaze Maintain *4$s and vitals 4'! 2)! ))! E87! Sp&9.

&rigination :;+9::<

'age = of 9

EMERGENCY MEDICAL RESPONDER (EMR) / EMERGENCY MEDICAL EC!NICIAN (EM )

)outine medical care *llo the patient to assume the position that minimizes or eliminates the s"mptoms usuall" the supine position. 4e are that as#ing the patient to turn their head or sit up! or testing the movement of their e-traocular muscles can trigger vertigo and result in vomiting. Tr" to avoid these unnecessar" movements. 'rovide o-"gen as necessar"

AD"ANCED EM (AEM ) / IN ERMEDIA E

$onsider 3V+3& ,S > T8&! if approved. 3f the patient appears to be deh"drated! consider a ?:: ml bolus of ,ormal Saline

Contact Medical Control for the following: *dditional fluid orders

PARAMEDIC
@se the follo ing medication for treatment of nausea and vomiting associated ith vertigoA o Re#lan =: mg 3V over =B9 minutes or =: 9: mg 3M @se the follo ing medication to reduce vertigoA o "al$u% ? mg 3V

Contact Medical Control for the following: 5urther orders ,otif" medical control if e-trap"ramidal side effects develop from the )eglan. These includeA a0 *#athisia b0 Torticollis c0 &pisthotonus d0 &cculog"ric crisis e0 4uccolingual crisis $onsider 4enadr"l 9? mg 3M or 3V to correct e-trap"ramidal side effects

&rigination :;+9::<

'age 9 of 9