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Vertigo Management
Aka: Vertigo Management
- See Also
- Vertigo
- Vertigo Causes
- Peripheral Causes of Vertigo
- Central Causes of Vertigo
- Meniere's Disease
- Motion Sickness
- Vestibular Neuronitis
- Benign Paroxysmal Positional Vertigo
- Perilymphatic Fistula (Hennebert's Sign)
- Acute Labyrinthitis
- Bacterial Labyrinthitis (Acute Suppurative Labyrinthitis)
- HiNTs Exam (Three-Step Bedside Oculomotor Examination)
- Horizontal Head Impulse Test (Head Thrust Test, h-HIT)
- Nystagmus
- Skew Deviation (Vertical Ocular Misalignment, Vertical Heterotropia, Vertical Strabismus)
- Dix-Hallpike Maneuver
- Dizziness
- Dysequilibrium
- Syncope
- Light Headedness
-
General
- Evaluate and treat specific Vertigo Causes
- Medications are indicated for symptomatic acute Vertigo
- Avoid longstanding use of symptomatic medications
- Stop medications to allow brain to equilibrate
- Early ambulation improves rate of recovery
- Rehabilitation Exercises
- Epley Maneuver
- Indicated for Benign Paroxysmal Positional Vertigo (BPPV)
- Prescribed program of head movements and activity
- Improves symptom adaptation and balance
- Yardley (2004) Ann Intern Med 141:598-605 [PubMed]
- Management: Symptomatic Therapy - Outpatient
- Precautions
- Limit to 3 days only (to allow central compensation to proceed)
- Over the counter medications (Category B in pregnancy)
- Meclizine (Antivert)
- Age >12 years: 25 mg orally every 6 hours as needed
- Precaution: Sedating
- Dimenhydrinate (Dramamine)
- Preferred as better Anti-emetic effect and less sedation than Meclizine
- Adults: 50-100 mg orally every 4-6 hours (max: 400 mg/day)
- Age 2-5: 12.5-25 mg orally every 6-8 hours (max: 75 mg/day)
- Age 6-12: 25-50 mg orally every 6-8 hours (max: 150 mg/day)
- Antiemetics
- Ondansetron ODT (Zofran ODT) 4 mg IV/IM/PO every 6 hours as needed
- Metoclopramide (Reglan) 10 mg orally every 6 hours as needed
- Benzodiazepines for severe symptoms (adult dosing)
- Avoid in most cases of outpatient Vertigo Management
- Diazepam (Valium) 5-10 mg orally every 6 hours
- Lorazepam (Ativan) 0.5-2 mg orally every 6 hours
- Management: Symptomatic Therapy - Emergency Department
- First Line agents with dual Anti-emetic and anti-Vertigo activity
- Promethazine (Phenergan)
- Dose: 6.25 to 12.5 mg slow IV push (or 12.25 to 25 mg IM/PO/PR) as needed every 6 hours
- Consider Ondansetron instead in the elderly due to Anticholinergic effects
- Dimenhydrinate (Dramamine)
- Dose: 50 mg IV every 4 to 6 hours prn
- Limited availability
- Other Anti-emetics
- Prochlorperazine (Compazine) 5-10 mg IV/IM every 3-4 hours as needed
- Ondansetron (Zofran) 4 mg IV/IM/PO every 6 hours as needed
- Other anti-Vertigo
- Lorazepam (Ativan) 0.5 to 2 mg IV/IM/PO every 6 hours as needed
- Diazepam (Valium) 2 mg IV or 5 mg IM/PO every 6 hours as needed
- References
- Ondrejka (2014) Crit Dec Emerg Med 28(10): 11-7
- Marill (2000) Ann Emerg Med 36:310-9 [PubMed]
- Swartz (2005) Am Fam Physician 71:1115-30 [PubMed]