Podcast 1019: Trauma Blunt Cardiovascular Injuries (BCVI)

Contributor: Aaron Lessen, MD

Educational Pearls:

Benign Paroxysmal Positional Vertigo (BPPV)

• Common inner ear condition that can cause dizziness

• Diagnosis of BPPV can help to avoid admissions and extra imaging

• Three categories: positional, horizontal, and anterior

• Positional is the most common

• Dizziness is not a positive indicator, a torsional nystagmus must be induced

• Dix's hallpike maneuver is done to diagnose and an epley maneuver is then used for treatment

• Horizontal

• Usually determined to be the case if the vertigo seems positional and the dix hallpike does not work. A supine roll test would then be done to help diagnose.

• Instead of a rotational nystagmus, a one-sided horizontal nystagmus is expected in order to determine a positive indicator

• Down-beating nystagmus is determined to be geotropic and is treated by a barbeque roll maneuver. While upbeating nystagmus is apogeotropic and is treated by Gufoni maneuver.

• Anterior is more rare

• Most cases require neuro consults

• Determined by attempting to induce a down-beating nystagmus, which is a more concerning nystagmus.

• Treatment is tilting their head back up in a similar way

• Inducing the nystagmus is not sided and is more central

References

1. Kim DY, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020.

2. Biffl WL, et al. Screening for and treatment of blunt cerebrovascular injuries: Western Trauma Association critical decisions algorithm. J Trauma. 2009.

3. Brommeland T, et al. Best practice guidelines for blunt cerebrovascular injury. Scand J Trauma Resusc Emerg Med. 2018.

4. Harper PR, et al. Routine CTA screening identifies blunt cerebrovascular injuries missed by clinical risk factors. Trauma Surg Acute Care Open. 2022.

Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P

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