The Dix-Hallpike maneuver is used to help diagnose benign paroxysmal positional vertigo (BPPV).
- Place the gurney's head of the bed down flat.
- Reposition the patient so that s/he is sitting another 12 inches or so closer towards the head of the flat gurney.
- Rotate patient's head 45 degrees.
- Help the patient lie down backwards quickly.
- The patient's head should be hanging off of the gurney edge in about 20 degrees extension.
- Observe for rotational nystagmus after a 5-10 second latency period, which confirms BPPV.
I find two things challenging in this maneuver.
- The patient often does not like to be moved AT ALL while feeling nauseously vertiginous. This even includes trying to reposition the seated patient closer to the head of the bed. This requires them to look behind them to see what where they are going, which sets off more vertigo.
- In some of our ED rooms and hallways, the head of the gurney bed is often abutting a wall, a portable monitor, or some equipment. It takes a little fancy shuffling to make room for the Dix-Hallpike maneuver.
Place blankets under the shoulders for the Dix-Hallpike maneuver
The key is to maintain about 20-30 degrees of neck extension to align the posterior semicircular canals with the direction of gravity. Placing several blankets under the patients' shoulders can accomplish this same position without having to scoot the patient close to the gurney edge. I'm sure the patient would appreciate keeping their head movement to a minimum.
Looks neat. When you're doing this, is there any badness in particular that you're trying to rule out, or are you just ruling-in?
ReplyDeleteWhen confirmed, do you do the Epley Maneuver in the ED?
Thanks as always!
@Rick: It is a test to rule in a common cause of peripheral vertigo - BPPV. When confirmed, I try the Epley maneuver but with variable success. Hmm, maybe next week's Trick of the Trade topic? Thanks for the idea.
ReplyDeleteAwesome, thanks! I'm going to go find someone to walk me through the Epley Maneuver tomorrow. I've never actually seen it in action.
ReplyDeleteRick - Check out YouTube. There are tons of videos there. I plan to use one for next week's post on Epley.
ReplyDeleteI'm on it. Forget this biochemistry nonsense I've been drudging through all day.
ReplyDeleteI've found it useful to print out a handout they can take home with them explaining the maneuver as well, so they can do it on their own if their symptoms return.
ReplyDeleteKit: Oooh, that is a wonderful idea. That is SO getting incorporated into next week's Trick of the Trade. Do you have a handout made out already? If so, can I use?
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ReplyDeleteWe have the same problem with head of the gurney being obstructed by walls, tables etc.
ReplyDeleteSolution: Just let the patient lie in the opposite direction and do the Epley with the head lying over the end of the bed.
CK: Ooh, Iike that trick. Sometimes the simplest solution is the best solution. Thanks!
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