Continuing Professional Development: Vertigo and pre-hospital care

After completing this module the paramedic will be able to:

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A common phrase used by patients is that they ‘feel dizzy’. Dizziness can be subdivided into three categories of vertigo, syncope and non-syncope, and non-vertigo dizziness. Vertigo is a medical condition where a person feels as if they or the objects around them are moving when they are not. Syncope is a condition of transient loss of consciousness (commonly termed as a faint). The ability of the body to feel ‘stable’ is triangulated through three elements. Information from the eyes, fine-tuned information from the inner ears (the vestibular system), and the body senses, such as touch. An example would be motion sickness – the body is still, but the eyes can see things moving, this can result in an information mismatch to the brain.

The paramedic as a first contact practitioner will consult a variety of patients with different conditions of dizziness. Some will be related to vertigo and some to syncope. Determining that the symptom described is vertigo will involve some deduction in the form of a comprehensive history-taking from the paramedic. It is not always clear what a patient means and the patient may describe vertigo amongst other presentations, e.g. along with pain from a head injury, or otalgia from an ear infection. Phrases like ‘the room is spinning’ or ‘I feel like I am spinning’ may be synonymous with the vertigo symptom. Vertigo, like many of these descriptions, is a symptom and not a diagnosis. Vertigo-associated disorders for diagnosis are categorised into the six main conditions of Benign Paroxysmal Positional Vertigo (BPPV), Vestibular Neuronitis (VN), labyrinthitis, Meniere's disease, central vertigo and vertigo of unknown origin. Other causes of dizziness not associated with syncope or vertigo are vast.