Video Lecture: The Optimal Diagnosis and Treatment of Emergency Department Dizziness and Vertigo Patients: The GRACE 3 Guideline Recommendations to the Rescue!

The 2023 GRACE-3 guideline recommendations are a valuable resource for understanding how to evaluate and treat ED patients with dizziness and vertigo. The publication by Dr. Jonathan Edlow, based on the work of a multi-disciplinary guideline panel, helps emergency clinicians to optimally diagnose and treat patients with this potentially catastrophic neurological illness.

Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE-3):
Acute dizziness and vertigo in the emergency department

Jonathan A. Edlow, MD et al Acad Emerg Med. 2023;30:442–486.

Have you ever been concerned that your Emergency Department patient with dizziness and vertigo might be having a TIA or posterior circulation stroke?

The Dizzy ED Patient: Grace-3 Guidelines To the Rescue

This guideline addresses the following:

How to categorize dizziness and vertigo patients using the ATTEST algorithm into three types of vertigo, AVS, s-EVS, and t-EVS, each with possible diagnoses related to systemic, central, and peripheral etiologies.
What are the neurological signs and symptoms that must be determined, including nystagmus, ataxia, the hearing and sensory exams, the HINTS+ test, and the STANDING protocol?
What are 15 recommendations that guide the clinical exam and evaluation, the use of neuroimaging, treatment with steroids, the use of the Dix-Hallpike test and the Epley maneuver, and proposed training strategies for emergency clinicians?
What are potential patient evaluation errors and proposed implementation strategies that can influence the utility of these patient care guidelines?

Edward Sloan, MD, MPH, FACEP

Professor Emeritus

Department of Emergency Medicine, University of Illinois at Chicago

FERNE President and Board Chair. No financial conflicts.