Dizziness in the ED: An Inside Look from PT and Physician Perspectives

Описание: Dizziness in the emergency department is common—and complicated. Today, hosts Dr. Abbie Ross, PT, NCS and Dr. Dani Tolman, PT talk with Dr. Peter Johns (MD) and Dr. Rebekah Griffith, PT about what actually works in the ED: using the HINTS exam correctly, avoiding unnecessary imaging and meclizine-only discharges, knowing when to call a stroke code, and why physical therapists in the ED can transform safety, outcomes, and costs.

You’ll hear about how to triage dizzy patients, spot posterior circulation stroke red flags, treat BPPV (Benign Paroxysmal Positional Vertigo) efficiently, and keep patients safe when answers aren’t immediate. We also cover topics such as orthostatic hypotension, POTS, rapid-access dizzy clinics, and practical discharge planning.


About the Guests:
Peter Johns, MD — Emergency Department physician and vertigo educator (creator of “Spin Class” vertigo course and a popular YouTube channel).
Dr. John's "Spine Class" Course: https://emneuro.com/spinclass/
Dr. John's YouTube Channel: ⁠   / @peterjohns  

Rebekah Griffith, PT, DPT — Emergency Department physical therapist and educator advocating for PT/OT presence in EDs nationwide.
Dr. Griffith's Website: ⁠https://theeddpt.com/
Instagram: https://www.instagram.com/theeddpt?ut...

Key Takeaways
-Use HINTS only in continuous dizziness with spontaneous nystagmus; otherwise it can mislead toward stroke workups.
-BPPV is common and under-treated—confirm with positional nystagmus and treat with the right maneuvers.
-Assess gait and orthostatics upright, not just vitals in bed; orthostatic hypotension is frequently missed.
-If no nystagmus + new gait impairment, don’t discharge—consider imaging/neurology.
-Embedding PTs in EDs improves safety, reduces unnecessary imaging and admissions, and boosts patient/provider satisfaction.
-Upstream PT access (outpatient/telehealth) prevents many ED visits and fear-avoidant patterns (e.g., PPPD risk).


If this episode helped you, subscribe, like, and share. Comment with your biggest ED dizziness challenge—and we may just cover it in a future episode!


#Dizziness #Vertigo #BPPV #HINTSExam #Stroke #EmergencyMedicine #VestibularRehab #PhysicalTherapy #POTS #OrthostaticHypotension #NeuroPT #TalkDizzyToMe


Hosted by:
🎤 Dr. Abbie Ross, PT, NCS
🎤 Dr. Danielle Tolman, PT
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Time Stamps
01:11 Dr. Johns: path to ED & vertigo education
02:41 Dr. Griffith: why PT belongs in the ED
04:01 What PTs actually do in the ED
06:52 Living with diagnostic ambiguity in the ED
07:21 How common is dizziness; risk of dangerous causes
08:17 PT share of dizzy patients in the ED
10:43 Why every ED should have PT (throughput, safety, cost)
13:27 ED goals for dizzy patients & discharge planning
14:52 Gait assessment as a safety linchpin
15:22 Rapid Access Dizzy (RAD) clinic model
16:21 When PT flags central signs & stroke alerts
18:09 HINTS exam: when to use it in the ED
20:56 Why no HINTS without nystagmus
23:23 Central “red flags” to screen before HINTS
25:18 Imaging realities: CT/CTA vs MRI, US vs Canada
27:36 How ED PTs cut holds, imaging, burnout
28:57 Discharging symptomatic but safe patients
30:21 When not to discharge: gait + no nystagmus
33:12 “Vertigo” isn’t a diagnosis—referrals that help
35:59 Most mismanaged: BPPV and posterior strokes
37:26 The sleeper culprit: orthostatic hypotension
39:24 POTS awareness & functional vitals in motion
42:12 Upstream care: keeping dizzy patients out of the ED
43:45 Training ED clinicians to manage dizziness
46:11 PT/OT courses to build ED programs
47:37 Hands-on feedback for HINTS proficiency