Show Notes
Dizziness in the emergency department is common... and complicated. Today, we 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 the stroke team, 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 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.
Episode Resources: Peter Johns, MD — Emergency physician and vertigo educator (creator of “Spin Class” vertigo course and a popular YouTube channel). Dr. John's "Spin Class" Course Dr. John's YouTube Channel
Rebekah Griffith, PT, DPT — Emergency Department physical therapist and educator advocating for PT/OT presence in EDs nationwide. Dr. Griffith's website Instagram
Key Takeaways: Use HINTS to rule in peripheral vestibular dysfunction BPPV is common and under-treated—confirm with positional nystagmus and treat with the correct maneuvers. Assess gait and orthostatics upright, not just vitals in bed; orthostatic hypotension is frequently missed. 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).
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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 linchpin15:22 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 nystagmus23:23 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 dizziness46:11 PT/OT courses to build ED programs 47:37 Hands-on feedback for HINTS proficiency
#Dizziness #Vertigo #BPPV #HINTSExam #Stroke #EmergencyMedicine #VestibularRehab #PhysicalTherapy #POTS #OrthostaticHypotension #NeuroPT #TalkDizzyToMe
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