Assessment and Management of Acute Vertigo

Details

Title

Assessment and Management of Acute Vertigo

Type

Stage Two

Module code

HPS235

Requirement

Compulsory

Module objective

By the end of this module Clinical Scientist in HSST, with respect to the assessment and management of acute vertigo, will be able to analyse, synthesise, evaluate and apply knowledge and perform a specialist assessment and treatment of patients with acute vertigo demonstrating the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist within a patient focused service and in particular will be able to: 

• determine the cause of the acute attack of vertigo.
• instigate and interpret an appropriate set of audiovestibular investigations.
• define a management plan.
• assess the impact of the attack on the individual and liaise with relevant professionals.
• explain to the patient the likely cause and outcome of the acute vertigo if peripheral in origin.

Knowledge and understanding

By the end of this module Clinical Scientists in HSST will analyse, synthesise, evaluate and apply their expert knowledge with respect to: 

• the anatomy and physiology of the vestibular system, vestibular pathways, and central vestibular control centres and how these maintain good balance and are influenced by metabolic disorders.
• the selection and validation of appropriate tests.
• the scientific quality assurance of test procedures.
• the validity and reliability of test results and their application.
• the pathomechanisms of an acute attack of vertigo.
• differentiation of peripheral causes from central causes of acute vertigo
• the various otological, neurological and general medical causes of acute vertigo and referral pathways.
• appreciation of the physiological impact of vision disorders or neurological disorders in patients with vestibular problems.the management options for acute vertigo including particle repositioning and customised vestibular rehabilitation.
• the different clinical presentations of acute vertigo, e.g. benign paroxysmal positional vertigo, vestibular neuritis, labyrinthitis, Ménierè’s disease, migrainous vertigo, central vestibular pathologies including stroke.
• eye movement abnormalities that may be associated with acute vertigo.
• how to investigate each of the causes of acute vertigo.
• the treatment options available for acute vertigo including the drugs that can be used, their pharmacological effects and prescribing details.
• the natural history of acute vertigo of peripheral origin.
• how eye movement disorders may impact on balance.
• the management options for acute vertigo including particle repositioning and customised vestibular rehabilitation.

Technical and clinical skills

By the end of this module Clinical Scientists in HSST, with respect to the assessment and management of acute vertigo, will be able to demonstrate a critical understanding of current research and its application to the performance and mastery of the following technical skills:

• perform a detailed neuro-otological examination within the scope of a Consultant Clinical Scientist including an accurate examination of the eye movements, characterising any nystagmus.
• perform tests of vestibular function including:
  • videonystagmography.
  • postural sway measurements, including Equitest.
  • tests of oculomotor function
  • tests of vestibulo-ocular function e.g. Halmagyi, head shaking, visual dynamic acuity
  • positioning tests including the Dix Hallpike manoeuvre.
  • caloric function testing including water and air calorics.
  • bedside test battery to identify signs distinguishing central from peripheral causes of acute vertigo.
  • Vestibular evoked myogenic potentials (VEMPs).request appropriate imaging to investigate acute vertigo, when indicated, and take appropriate action on the findings.
• use of systems for ensuring the quality assurance of test procedures.
• use of appropriate internal controls and performance monitoring.
• internal and external quality assurance.
• apply knowledge of the validity and reliability of test results and their application.
• uncertainty of measurement.
• use of systems to produce timely, accurate and relevant reports with appropriate interpretative comments.
• request appropriate imaging to investigate acute vertigo, when indicated, and take appropriate action on the findings.

By the end of this module Clinical Scientists in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills to advise and communicate effectively with patients, their families and carers, and other healthcare professionals and will:

• distinguish peripheral from central vestibular causes of acute vertigo by an accurate history, focused examination and investigation as appropriate in the role of Consultant Clinical Scientist.
• suspect a general medical or neurological cause of acute vertigo from the history and refer appropriately.
• recognise pathology in the other stabilising sensory and effector motor systems by a good history and examination making appropriate onward referral.
• assess any associated psychological factors and refer as necessary.
• devise and implement a programme of vestibular rehabilitation tailored to the individual, monitoring and reappraising management in line with progress working with the multi-disciplinary team including:
  • perform particle repositioning manoeuvres e.g. Epley, Semont.
  • instruct the patient in appropriate vestibular rehabilitation e.g. Cawthorne- Cooksey, Brandt-Darroff and visual exercises.
• interpret a full battery of audio-vestibular tests.
• discuss management options with the patient.
• implement appropriate management including referral to other specialties (e.g. audiovestibular medicine, ENT, neurology and general medicine) .
• administer and analyse questionnaires as outcome measures for vestibular function and quality of life.
• reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence.

Attitudes and behaviours

By the end of this module Clinical Scientists in HSST will be expected to evaluate their own response to both normal and complex situations demonstrating the professional attributes and insights required of a Clinical Scientist in HSST working within the limits of professional competence referring as appropriate to senior staff and will:

• maintain patient confidentiality.
• treat patients, their families and carers with respect.
• include the patient in any decision making
• treat all clinical and non-clinical staff with respect .
• recognise and work within own limitations in knowledge and expertise.
• refer to more experienced colleagues as appropriate.
• work effectively within a multi-disciplinary framework/team.
• be committed to and support continuous improvement of therapeutic services, with particular reference to auditing practice, evidence based practice, innovative, new and improved technologies.