AI Summary
5 min readEp 224 Vertigo Part 1: Approach to Episodic Vertigo
When Dr. Alicia Targansky found herself at a family wedding abroad, she started feeling nauseous, sweaty, and uncomfortable. She thought she might be having a vasovagal episode. But when she lay down, "it hit me like a ton of bricks — suddenly spinning sensation, the room was spinning around me." She performed the Dix-Hallpike test on herself, had her wife film her eye movements, diagnosed herself with benign paroxysmal positional vertigo (BPPV), and performed the Epley maneuver. On the third step, she felt terrible — and messaged Dr. Peter Johns, who replied, "The rocks are rolling." She was cured. That personal experience turned Targansky into a "BPPV crusader," and it illustrates something the episode makes clear: vertigo can be confusing even for experts, but with the right approach, it becomes one of the most satisfying conditions to manage in the emergency department.
Why symptom descriptions are unreliable
Continue reading the full summary in the app — free to try.
Read Full Summary →Free • No credit card required
Never miss an episode of Emergency Medicine Cases
Get every new episode summarized in your inbox — free, ~5 minutes to read.
No spam. Unsubscribe anytime.
What you'll learn
- 1 (01:30) **The Dizziness Problem & Why It Matters** - Introduction to the episode: vertigo is daunting but rewarding; 2-5% of ED visits; two-part series on episodic (this episode) and continuous vertigo (next).
- 2 (03:23) **Meet the Experts & Their Origin Stories** - Dr. Alicia Targansky describes her own BPPV attack and self-diagnosis; Dr. Peter Johns explains his 25-year journey from textbook myths to curing patients.
- 3 (08:54) **Pitfall #1: Don't Rely on Symptom Descriptions Alone** - Up to 50% of dizzy patients change their description during the visit; "room spinning" vs. "about to faint" is not reliable. The key question is movement vs. loss of consciousness.
- 4 (11:46) **Peter's Approach: Timings & Triggers** - Shift from "what do you mean by dizzy" to the timing and triggers framework: how long does it last? Is it still there? Is it provoked by position change?
- 5 (15:31) **Drilling Down on Symptom Timing** - Tips for the "vague" patient who says they've been dizzy all day. Ask: *What were you doing the moment before the dizziness started?* Distinguish brief spinning from prolonged nausea/queasiness.
- 6 (19:38) **Myth-Busting: Movement Makes It Peripheral?** - **Myth Busted:** All dizziness gets worse with movement, including central causes like posterior circulation stroke. Movement cannot differentiate peripheral from central.
- 7 (22:53) **The GRACE-3 Guidelines & Three Vestibular Syndromes** - Overview of the 2023 GRACE-3 paper: Acute Vestibular Syndrome (AVS), Spontaneous Episodic Vestibular Syndrome (SEVS), and Triggered Episodic Vestibular Syndrome (TEVS).
+ Full timestamped outline available in the app
Show Notes
Vertigo is one of the most dreaded chief complaints in Emergency Medicine – for good reason! Symptoms can be vague, the assessment can be nuanced, and there are so many potential pitfalls along the way for accurately investigating and diagnosing dizzy patients. What do we actually need to know about risk stratifying these patients at the bedside? What red flags are most helpful to screen for? How do we tease out the useful parts of the history and physical exam to guide our diagnostic strategy? In this Vertigo Part 1 episode, Katie is joined by emergency physicians and vertigo gurus Dr. Peter Johns and Dr. Elisha Targonsky to outline a practical 4-step approach to assessing patients with EPISODIC vertigo and key clinical pearls to make your next vertigo assessment so much easier. Stay tuned for the upcoming paired Vertigo Part 2 episode that will cover an approach to continuous vertigo… If you find EM Cases content helpful for your practice, please consider contributing a donation to help us continue producing free, high-quality, and open-access emergency medicine educational content here: https://emergencymedicinecases.com/donation/
More from this podcast
Emergency Medicine Cases →