Acute onset dizziness, nausea, headache part 2


• Scene – VS, EKG, IV, BG, Zofran,

• En Route – vitals, dim lights, TT

• Hospital – unknown


• Response to treatment – pt felt a little better but still had dizziness after Zofran


Elliot Williams, Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Vertigo

Differential Diagnosis

• Vertigo

• Adverse reaction to medications

• CVA/stroke

• Migraine variant headache

• Psychogenic (conversion)

• Inner ear diseases

• Meniere disease

• Benign paroxysmal positional vertigo

• Labyrinthitis

Patient Workup History

• Patient states – This is the worst vertigo I have ever had. I can not even move. Normally I can do some excercises that help, but today i can’t do them. I woke up at 0700 and had to go to the bathroom and could not get out of bed because of the dizziness.

• Spouse states – This is the worst it has ever been. She took her meds but they have not helped at all.

Physical Exam

• Severe vertigo and nausea, HA, light sensitive

• CBG – 93

• EKG – SR

Editor’s Notes

Vertigo has many etiologies, including a reaction to medications. This patient has a known diagnosis of lymphoma. Having a good understanding of what medications have been taken, including chemotherapy medications, may be helpful. Vertigo is a form of dizziness in which the patient perceives a spinning motion either around them or inside their own head. -Dr. David Spiro What is most important is the way the paramedic calmly explained how he was going to evaluate (vitals initially) and treat (IV access, Zofran) symptoms.This patient was clearly distressed about her symptoms. Part of the job for a paramedic and clinician is to address pain and anxiety with our patients.

-Dr. David Spiro

Suggested References

Dizziness, vertigo and imbalance


• Gender: Female

• Age: 68 years

• Height: Not Available

• Weight: Not Available


• Temperature: 97.6 F/ 36.4 C

• Blood Pressure: 133/87 • Heart Rate: 84

• Respiratory Rate: 18

• Pulse Oximetry: 100% RA

Signs and Symptoms

Severe dizziness, nausea, HA

History Medical

• PMH: T-cell lymphoma non-Hodgkin, vertigo, neuropathy, back surgery

• Dispatch info: C/B/A vertigo

• Allergies: CN, MS, Vicodin, OxyContin


• Lives with spouse

• Well kept home, non-smoker, non-drinker.


• lorazepam, morphine, vicodin, oxycontin

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