DIZZINESS - 09/09/11
Résumé |
Dizziness is a commonly encountered complaint in the emergency department (ED) and accounts for approximately 1.5% of all hospital admissions.13, 35, 40 In one survey, 26% of all ED patients stated that they had experienced dizziness.28 Dizziness may be the most common non–pain-related physical complaint seen in the ED. In primary care practices, it is reported that dizziness accounts for 8 million outpatient visits per year in the United States.40 In fact, all people experience dizziness at some point during their lives. If dizziness is so frequently encountered, what precipitates a patient with dizziness to present to the ED? There are two primary reasons why people experiencing dizziness present to the ED: (1) it interferes with their normal daily activities, and (2) the patient is concerned that they might have a serious underlying disease process.41, 51
Dizziness is uncommon in children, but becomes more common in adults as a function of age. In fact, dizziness affects more than 50% of elderly patients and is the commonest complaint of patients over 75 years of age.26 In the elderly, dizziness can lead to falls and significant injuries. When troubled by dizziness, older patients often refrain from physically strenuous activities, social events, and travel. Accordingly, a fear of dizziness can cause these senior citizens to withdraw socially and facilitate their functional decline.8, 25
For many emergency physicians, the clinical evaluation of dizziness is a difficult and perplexing task. The primary reason for this frustration is because dizziness is a nonspecific symptom that describes a subjective sensation that is virtually impossible to objectively measure. Patients use the term dizziness to describe a perception of altered variation in spatial awareness.3 This perception ranges from a general sense of illness, to fatigue, weakness, lightheadedness, fainting, disequilibrium, or an illusion of motion (vertigo). The cause of these perceptions can range from labyrinthitis to cerebral hemorrhage to cardiac arrhythmias to orthostatic hypotension to volume depletion. It is readily apparent to the clinician that the ability to rapidly focus on one organ system dysfunction to explain or account for the patient's presentation is not possible—especially in the aged. Multiple systems maintain the proper perception of the relationship between the person and the environment. These systems include the vestibular, visual, and proprioceptive systems. Accordingly, the differential diagnosis can be quite lengthy. Regretfully, there is no quick and simple method to identify patients, especially older patients, at risk for “serious” causes of dizziness.
The purpose of this article is to present a systematic approach to the evaluation and management of the dizzy patient from the perspective of the emergency physician, with an emphasis on a management strategy that is timely and cost effective. Subsequently, obtaining a precise and accurate history and physical examination cannot be stressed enough, because in the evaluation of this complaint, laboratory tests and imaging studies are of little, if any, diagnostic value. The first portion of the article focuses on adults, particularly the geriatric patient, and the second portion of the article concentrates on pediatric patients.
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| Address reprint requests to James S. Walker, DO, FACEP, Section of Emergency Medicine, P.O. Box 26307, Room EB-319, Oklahoma City, OK 73126 |
Vol 16 - N° 4
P. 845-875 - novembre 1998 Retour au numéro
Article précédent
- ACUTE VISUAL CHANGE
- Alan Morgan, Robin R. Hemphill
- CHRONIC RECURRENT ABDOMINAL PAIN
- Scott W. Zackowski
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