Urgent Updates | September 28

Updated Guidelines on Acute Dizziness, Vertigo in the Emergency Department

The Society for Academic Emergency Medicine has released a new guideline on diagnosing and managing adults who present to the emergency department with acute dizziness and vertigo of less than 2 weeks’ duration. Among the recommendations:  Clinicians should be trained in the head impulse, nystagmus, test of skew (HINTS) bedside examination for patients with acute vestibular syndrome (AVS) as well as diagnostic and therapeutic approaches for benign paroxysmal positional vertigo (BPPV). To determine central from peripheral causes in patients with AVS, clinicians should use HINTS in patients with nystagmus, use finger rub in these patients to exclude stroke, not utilize brain computed tomography or routine magnetic resonance imaging, and more. Clinicians should consider short-term steroids to treat patients with vestibular neuritis. Clinicians should utilize the Epley maneuver in patients with posterior canal BPPV. Full Access: Consultant360

A Case-Based Exploration on How We Address High Blood Pressure Concerns in Urgent Care

High blood pressure is a common incidental finding in urgent care. Distinguishing patients who may need treatment from those who should be advised to follow up for further evaluation is well within the urgent care provider’s field of expertise. This article will address some of the common scenarios I’ve observed involving patients with elevated BP readings and review the most recent guidelines and evidence-based approaches to such cases. Full Access: JUCM

Fatal Fleaborne Typhus in Los Angeles County – Incidence of fleaborne typhus cases — some lethal — has risen in the past 2 years.

Fleaborne typhus is a zoonotic disease caused by Rickettsia typhi and transmitted by bites of infected fleas found primarily on cats. Presentation includes fever, headache, rash that spares the palms and soles, hepatitis, and thrombocytopenia. More-severe illness may involve hemophagocytic lymphohistiocytosis (HLH), myocarditis, and septic shock. The pathogen is susceptible to tetracyclines; mortality is <1% in patients receiving doxycycline. In California — where fleaborne typhus is endemic — case rates have been rising since 2010, and a high of 171 cases was reported in Los Angeles County in 2022. Full Access: NJEM

Increased Respiratory Syncytial Virus (RSV) Activity in Parts of the Southeastern United States: New Prevention Tools Available to Protect Patients

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians about increases in respiratory syncytial virus (RSV) activity across some parts of the Southeastern United States in recent weeks, suggesting a continued shift toward seasonal RSV trends observed prior to the COVID-19 pandemic. Historically, such regional increases have predicted the beginning of RSV season nationally, with increased RSV activity spreading north and west over the following 2–3 months. RSV can cause severe disease in infants, young children, and older adults. Full Access: CDC