Benzo for Dizziness

[DwayneEMTP]

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I would have to ask (and not being a smart ass) what diagnostic tool you would use to determine that dizziness is vertigo, ear infection, a CVA/TIA, electrolyte imbalance, or a brain tumor ?

Is your point then that you will not treat anything but a simple lac/abrasion without a full diagnostic workup at the hospital? I'm not sure what your point is here....

... I do not see "vertigo" as something that needs immediate treatment in the field,

Then I would guess that you've never had a true vertigo. These are truly some of the most terribly miserable patients I've seen. The places that I've worked have always allowed Promethazine and it works like a champ. I've never heard of using benzos, but it sounds interesting. I wonder why it works?

... unless you are trying to do something to treat and release, but again, you do not have the tools to determine if the patient can be left at home.

I was getting ready to stomp on this statement but I'm guess that you aren't suggesting that we don't have the tools to allow anyone to stay home, but just speaking in general of the dizziness patient?

Dwayne

[Bieber]

I was just reading up on Meniere's disease the other day, and yeah, benzo's can be used in an acute setting for vertigo. I applaud those services who utilize them for going that extra mile for the sake of patient care.

Hatelilpeeps, not every patient can be safely determined to be stable enough for treat and release care, but we do have the tools and the capabilities to make sound decisions on a good number of them; we only lack the educational background. Also, by your reasoning, we shouldn't give pain control for patients with abdominal pain because we can't know what's going on inside of them with one hundred percent accuracy.

[croaker260]

We use benzos for "nausea/vomiting with inner ear/vertigo s/s". We have for many years and are quite comfortable with it, I cant think of any adverse situations other than the rare over-sedation...but then again we prefer Valium in this role and NOT versed....

Obviously there are huge pitfalls of releasing these on scene, the largest one being the unrecognized vestibular artery rupture/pathology....fortunately (generally speaking) the patient who receives narcotics is getting a trip to the ER so the t/r issue isnt there.

[Just Plain Ruff]

I've worked at a service that both allowed benzo's for vertigo as well as Antivert po for vertigo

Benzo for the acute phase and the antivert for when the benzo wore off. If we got far enough to consider giving Antivert then the patient was transported. We would tell the patient that we had other medications in the ambulance but they had to go to the hospital to get the other medication.

I can tell you that the patients were more than glad to go with me if I could take care of their vertigo

I quite routinely get vertigo based on my blood sugar. If it gets too high or too low, I get vertigo and I know to check my blood sugar.

If I get vertigo not related to sugar problems, I can tell you that I would love to have antivert or a benzo to take away the spinning.

[Chief1C]

Lay the cot flat, have them lay on one side, and turn the lights down. Maybe open a window.

[NYCEMS9115]

I am all for advancements in PHC/EMS but hearing drugs that are given for various complaints where the complaints are not life threatening such as dizziness. Are we (we meaning EMS/PHC as a whole) going into Internal/Primary Care Prehospital Medicine? I think we are. Benzos for dizziness seems like it is moving into that direction. Well on the surface, that is. I am all for that; job security and longevity but can we advance the education then? Degrees with longer Paramedic didactic training with the abolishing of Certificate Programs.

Personal opinion, not fact. No one (when I say no one, I mean 0 people) has to agree with me.

[ERDoc]

I am all for advancements in PHC/EMS but hearing drugs that are given for various complaints where the complaints are not life threatening such as dizziness. Are we (we meaning EMS/PHC as a whole) going into Internal/Primary Care Prehospital Medicine? I think we are. Benzos for dizziness seems like it is moving into that direction. Well on the surface, that is. I am all for that; job security and longevity but can we advance the education then? Degrees with longer Paramedic didactic training with the abolishing of Certificate Programs.

Personal opinion, not fact. No one (when I say no one, I mean 0 people) has to agree with me.

You don't think relieving someone's suffering would come under EMS? When we talk about vertigo we are not talking about simple dizziness. We are talking about someone who feels like they are going to die and have controlable vomiting with any movement. It's not life threatening but most people who have it wish they were dead. Morphine won't save lives either but that is commonly used in the field.

[R0B]

I have worked at several agencies from rural to urban municipalities in Texas, and have never encountered anyone in my area with a protocol to treat vertigo in the field. I have to somewhat agree with the curiosity about an accurrate diagnosis prior to treatment and how one would come to that. Also, I feel like there would be a lot more calls from people with vertigo if we start hooking them all up with valium, etc... just playing devil's advocate a little, interesting question though. Same as the NY guy, we use Zofran or Phenergan in the nausea/vomitting protocol. Rob

[DwayneEMTP]

I have worked at several agencies from rural to urban municipalities in Texas, and have never encountered anyone in my area with a protocol to treat vertigo in the field. I have to somewhat agree with the curiosity about an accurrate diagnosis prior to treatment and how one would come to that. Also, I feel like there would be a lot more calls from people with vertigo if we start hooking them all up with valium, etc... just playing devil's advocate a little, interesting question though. Same as the NY guy, we use Zofran or Phenergan in the nausea/vomitting protocol. Rob

I would be willing to bet that every one of those agencies had a protocol for Vertigo, they just hid it under the N/V heading. They have one for N/V, right? Spinning that is sometimes relieved but returns with even the slightest movement, uncontrollable vomiting. These people will truly be trying to become part of whatever they are laying on so that they limit their movement to the least possible. Nearly asymptomatic if motionless in between bouts of vomiting, but remaining motionless is of course nearly impossible for more than a few seconds. Give them Phenergan. If you carry it I'm guessing you have a n/v protocol for it, and these folks will fit it.

I've had several vertigo patients that I am aware of, and I can guarantee you that those that are questioning whether or not to treat them have never had one. Questioning whether to treat them is like questioning whether or not pain management is appropriate for a femur fracture. There is no question.

12.5-25 mg Phenergan IVSP/diluted and it has in each instance been akin to a miracle. Vomiting stops, pt states that they can breath and move without head spins...One of the most significant interventions I've ever provided.

Please man, tell me that you are not advocating that we withhold pain/mitigation of suffering because doing so will limit the number of fakers we have to respond to??

Dwayne

[Lone Star]

I would be willing to bet that every one of those agencies had a protocol for Vertigo, they just hid it under the N/V heading. They have one for N/V, right? Spinning that is sometimes relieved but returns with even the slightest movement, uncontrollable vomiting. These people will truly be trying to become part of whatever they are laying on so that they limit their movement to the least possible. Nearly asymptomatic if motionless in between bouts of vomiting, but remaining motionless is of course nearly impossible for more than a few seconds. Give them Phenergan. If you carry it I'm guessing you have a n/v protocol for it, and these folks will fit it.

I've had several vertigo patients that I am aware of, and I can guarantee you that those that are questioning whether or not to treat them have never had one. Questioning whether to treat them is like questioning whether or not pain management is appropriate for a femur fracture. There is no question.

12.5-25 mg Phenergan IVSP/diluted and it has in each instance been akin to a miracle. Vomiting stops, pt states that they can breath and move without head spins...One of the most significant interventions I've ever provided.

Please man, tell me that you are not advocating that we withhold pain/mitigation of suffering because doing so will limit the number of fakers we have to respond to??

Dwayne

When my cerebral aneurysm presented, I felt like I was on the merry-go-round from hell!

Not only was there that 'spinning feeling' but it also felt like I was pulling barrel rolls and loop-de-loops as well. I wasn't exactly nauseated, but I would have paid any price just to get it to stop!

The biggest difference I noted between that and the ever popular 'bed spins' from drinking was that with the 'bed spins', you can put a foot on the floor and it usually goes away because you've got a solid point of reference. With vertigo, it doesn't work that way. You keep telling yourself that the floor is solid, and you're not actually spinning; but the reference point spins and tilts right along with you. It's more than just a 'scary feeling', it's down right terrifying!

If someone were to tell me that I couldn't have a certain medication to ease those feelings, simply because they thought I might be faking; well, I can almost assure you that there would be someone getting hurt!

Granted, I'm very 'uneducated' when it comes to pharmacology (that starts next week), but I can see absolutely no justification in withholding comfort/pain management measures; and the provider that DOES needs either remedial training or removal from that position.

I'm not talking about the junkie that needs 'tweaked' because it's getting close to their next fix....I'm talking about those patients that have shown a bona fide NEED for symptom alleviation (i.e. pain management, vertigo).