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Dizziness Presyncope Smart Phrase

Description: the preliminary workup assessment and plan block for dizziness and presyncope.

Dizziness smart phrase:

Dizziness/Presyncope: DDx includes orthostatic hypotension, cardiac source, vestibular disorders, , anxiety/depression, medication induced. Evaluation plan:

Orthostatic hypotension
- Check orthostatic vital signs; IVF if orthostatic
- Daily weights
Cardiac source: History of ***arrythmia ***aortic stenosis, and physical exam shows ***irregularly irregular rhythm, ***bradycardia, ***tachycardia, ***murmur suggesting cardiac source to pre-syncope
- Telemetry
- Echocardiogram
Migraine: History of ***
headache, photophobia, visual aura or changes, and previous migraines suggest migraine possible source.
CNS disorder: History of ***atrial fibrillation (CHADS2 score) on***not on coumadin, ***previous CVA, ***seizure disorder, with neuro exam findings of ***, suggest a neuro origin to dizziness.
- Head CT
- If Head CT negative for bleed, permissive hypertension, daily aspirin
- Frequent neuro checks
Vestibular disorders: Vertigo (sensation of movement while sationary) suggests of vestibular source. History of ***brief (less than 30 s) dizziness with head movement in one direction and no tinnitus consistent with BPPV ***prolonged (longer than 30 s) dizziness, tinnitus, and nausea that has been happening for more than 2 weeks consistent with Meniere's disease ***prolonged (longer than 30 s) dizziness for less than 2 weeks and a recent URI consistent with viral vestibulitis or labyrinthitis ***worsening dizziness, hearing loss, tinitus, papilledema, other cranial nerve deficits (esp CN 7, 9/10) concerning for vestibular schwannoma (AKA acoustic neuroma).
- Otoscopic exam shows ***
- Ophthalmoscopic exam shows ***yes/no papilledema
- ***Dix-Hallpike test for BPV
- ***If hearing loss or tinnitus: Audiology testing
- ***If concern for schwannoma or Meniere's disease: Brain MRI with thin slices through posterior fossa
Anxiety/depression: History of *** suggests anxiety/depression as a contributing factor.
Medication: Recent medication addition/change of ***

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