vertigo_peripheral

  • -Working Diagnosis:Evaluation for dizziness
  • – Ddx:(evaluation includes but was not limited to):
    • vertigo peripheral,
    • vertigo central,
    • presyncope
    • syncope
    • cardiogenic presyncope
    • neurogenic presyncope
    • vasovaguel response
  • – ED Course:
    • Improvement after meclizine. Ambulatory with steady gate. Normal neuro exam.
    • Re-evaluation after above interventions/observation: improved
    • Requesting to go home.
  • – Pertinent Diagnostics Contributory toMDM:
    • Hx is consistent with vertigo. Not consistent with presyncope.
  • - Therapeutically:
    • meclizine
  • MDM:
  • DIAGNOSIS: Peripheral vertigo
  • RATIONALE:Suspected given evalc/w peripheral vertigo,
    • Specifically:
      • – intermittent,
      • – hx of perhipheral vertigo,
      • – provocation by position,
      • – abrupt onset and resolution,
      • – no high risk factors for central process,
      • – no concerning for central process given resolution of sx
      • – hxnot consistent with presycope/syncope
  • Hx is consistent with vertigo. Not consistent with presyncope. Not c/w central vertigo and does not meet sufficient criteria where nuero consult orMRI would be of diagnostic utility. While a central process cannot be definitely excluded at this time, shared decsion making utilized and mutual agreement for discharge with strict follow up and return precautions.
  • – other pathology entities sufficiently excluded.Evaluation was not sufficiently consistent the following entities to meet threshold for ED further diagnostics/interventions making risks outweigh benefit of further diagnostics/interventions for the patient i.e. not consistent with these conditions(consideration included but limited to these conditions) given above rationale:
    • vertigo central,
    • presyncope, syncope,
    • cardiogenic presyncope
    • neurogenic presyncope
    • vasovaguel response
  • Plan:
    • Discussed return precautions with pt including but not limited to lack of improvement, worsening sx, developing new sx,
  • Dispo:
    • home, prompt PMD f/u, return to EDprecautionsspecific for this process.

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