Dizziness

Addisonian CRISIS: hypotension/shock, vomiting, hyponatraemia, hypoglycaemia, often triggered by illness/surgery → emerg

Symptomatic postural hypotension with falls; severe gastroparesis; coexisting cardiac autonomic involvement

Perforation with vertigo/sensorineural loss after trauma → suspect ossicular/inner-ear injury (perilymph fistula) → urge

Underlying Addisonian crisis risk; new autoimmune endocrinopathy → screen for the others

Recurrent falls/injury in the elderly → address as a falls risk (cross-ref acute_care falls framework)

Central features (HINTS exam suggesting stroke — direction-changing nystagmus, normal head-impulse test, skew deviation)

Within the thrombolysis window, large-vessel occlusion, fluctuating/worsening deficit; exclude haemorrhage first

Persistent/vertical/non-fatiguing nystagmus or other neurology → central cause (posterior fossa) → image

Adverse features (shock, syncope, myocardial ischaemia, heart failure) or risk of asystole (Mobitz II, complete block, r

Reduced consciousness, neurological signs, cardiac ischaemia, pregnancy → consider hyperbaric oxygen

Stroke/TIA from dissection → urgent stroke pathway; thrombolysis decisions need imaging confirmation

Facial nerve palsy, vertigo, severe headache or meningism = intracranial/labyrinthine complication → urgent ENT/neurosur

Haemodynamic instability/collapse, shoulder-tip pain, peritonism → rupture → resuscitate + emergency surgery

Within the thrombolysis window (≤4.5h), large-vessel occlusion (thrombectomy), fluctuating deficit; exclude haemorrhage

Asymmetric/progressive features warrant MRI to exclude a vestibular schwannoma; drop attacks (Tumarkin) risk injury

Any asymmetric/unilateral sensorineural hearing loss → MRI to exclude this; brainstem compression if large

Severe deep pain, granulation tissue in the canal, cranial nerve palsy (esp. facial) in a DIABETIC/immunocompromised pat