Dizziness in the emergency department is common—and complicated. Today, hosts Dr. Abbie Ross, PT, NCS and Dr. Dani Tolman, PT talk with Dr. Peter Johns (MD) and Dr. Rebecca Griffith, PT about what actually works in the ED: using the HINTS exam correctly, avoiding unnecessary imaging and meclizine-only discharges, knowing when to call stroke, and why physical therapists in the ED can transform safety, outcomes, and costs.
You’ll hear about how to triage dizzy patients, spot posterior circulation stroke red flags, treat BPPV efficiently, and keep patients safe when answers aren’t immediate. We also cover topics such as orthostatic hypotension, POTS, rapid-access dizzy clinics, and practical discharge planning.
About the Guests
Peter Johns, MD — Emergency physician and vertigo educator (creator of “Spin Class” vertigo course and a popular YouTube channel).
Rebecca Griffith, PT, DPT — Emergency Department physical therapist and educator advocating for PT/OT presence in EDs nationwide.
Key Takeaways
Use HINTS only in continuous dizziness with spontaneous nystagmus; otherwise it can mislead toward stroke workups.
BPPV is common and under-treated—confirm with positional nystagmus and treat with the right maneuvers.
Assess gait and orthostatics upright, not just vitals in bed; orthostatic hypotension is frequently missed.
If no nystagmus + new gait impairment, don’t discharge—consider imaging/neurology.
Embedding PTs in EDs improves safety, reduces unnecessary imaging and admissions, and boosts patient/provider satisfaction.
Upstream PT access (outpatient/telehealth) prevents many ED visits and fear-avoidant patterns (e.g., 3PD risk).
If this episode helped you, subscribe, like, and share. Comment with your biggest ED dizziness challenge—and we may just cover it in a future episode!
#Dizziness #Vertigo #BPPV #HINTSExam #Stroke #EmergencyMedicine #VestibularRehab #PhysicalTherapy #POTS #OrthostaticHypotension #NeuroPT #TalkDizzyToMe
Hosted by:
🎤 Dr. Abbie Ross, PT, NCS
🎤 Dr. Danielle Tolman, PT
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Time Stamps01:11 Dr. Johns: path to ED & vertigo education02:41 Dr. Griffith: why PT belongs in the ED04:01 What PTs actually do in the ED06:52 Living with diagnostic ambiguity in the ED07:21 How common is dizziness; risk of dangerous causes08:17 PT share of dizzy patients in the ED10:43 Why every ED should have PT (throughput, safety, cost)13:27 ED goals for dizzy patients & discharge planning14:52 Gait assessment as a safety linchpin15:22 Rapid Access Dizzy (RAD) clinic model16:21 When PT flags central signs & stroke alerts18:09 HINTS exam: when to use it in the ED20:56 Why no HINTS without nystagmus23:23 Central “red flags” to screen before HINTS25:18 Imaging realities: CT/CTA vs MRI, US vs Canada27:36 How ED PTs cut holds, imaging, burnout28:57 Discharging symptomatic but safe patients30:21 When not to discharge: gait + no nystagmus33:12 “Vertigo” isn’t a diagnosis—referrals that help35:59 Most mismanaged: BPPV and posterior strokes37:26 The sleeper culprit: orthostatic hypotension39:24 POTS awareness & functional vitals in motion42:12 Upstream care: keeping dizzy patients out of the ED43:45 Training ED clinicians to manage dizziness46:11 PT/OT courses to build ED programs47:37 Hands-on feedback for HINTS proficiency
