The ED call
The bedside exam is done and the findings are in front of you. Now make the decision that decides the patient: image, admit, or send them home.
Patient 1 of 90/0 correct
At the bedside
A 39-year-old has had constant vertigo for two days after a cold, with nausea and unsteadiness. It is present at rest, worse in the dark, and does not come in spells. Hearing is normal. They can walk, unsteadily, without help.
Findings at the bedside
- Head impulse
- Abnormal to the left — a catch-up saccade brings the eyes back to target.
- Nystagmus
- Unidirectional, horizontal. The fast phase beats the same way in every gaze position.
- Test of skew
- No vertical refixation on the alternate cover test.
What do you do now?
The exam is done. This is the disposition.