Dizziness in the emergency department is common... and complicated. Today, we talk with Dr. Peter Johns (MD) and Dr. Rebekah 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 the stroke team, 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.

Episode Resources:

• Peter Johns, MD — Emergency physician and vertigo educator (creator of “Spin Class” vertigo course and a popular YouTube channel).

  • Dr. John's "Spin Class" Course
  • Dr. John's YouTube Channel

  
  

  Rebekah Griffith, PT, DPT — Emergency Department physical therapist and educator advocating for PT/OT presence in EDs nationwide.

  • Dr. Griffith's website
  • Instagram

  
  

  Key Takeaways:

  • Use HINTS to rule in peripheral vestibular dysfunction
  • BPPV is common and under-treated—confirm with positional nystagmus and treat with the correct maneuvers.
  • Assess gait and orthostatics upright, not just vitals in bed; orthostatic hypotension is frequently missed.
  • 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., PPPD 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!

  
  

For more FREE resources, click ⁠⁠⁠here⁠.⁠⁠

Hosted by:

🎤 Dr. Abbie Ross, PT, NCS

🎤 Dr. Danielle Tolman, PT

For episode recommendations or requests, email us at: ⁠⁠⁠⁠⁠⁠⁠⁠[email protected]⁠⁠⁠⁠⁠⁠⁠⁠

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Time Stamps:

01:11 Dr. Johns: path to ED & vertigo education

02:41 Dr. Griffith: why PT belongs in the ED

04:01 What PTs actually do in the ED

06:52 Living with diagnostic ambiguity in the ED

07:21 How common is dizziness; risk of dangerous causes

08:17 PT share of dizzy patients in the ED

10:43 Why every ED should have PT (throughput, safety, cost)

13:27 ED goals for dizzy patients & discharge planning

14:52 Gait assessment as a safety linchpin15:22 Rapid Access Dizzy (RAD) clinic model

16:21 When PT flags central signs & stroke alerts

18:09 HINTS exam: when to use it in the ED

20:56 Why no HINTS without nystagmus23:23 Central “red flags” to screen before HINTS

25:18 Imaging realities: CT/CTA vs MRI, US vs Canada

27:36 How ED PTs cut holds, imaging, burnout

28:57 Discharging symptomatic but safe patients

30:21 When not to discharge: gait + no nystagmus

33:12 “Vertigo” isn’t a diagnosis—referrals that help

35:59 Most mismanaged: BPPV and posterior strokes

37:26 The sleeper culprit: orthostatic hypotension

39:24 POTS awareness & functional vitals in motion

42:12 Upstream care: keeping dizzy patients out of the ED

43:45 Training ED clinicians to manage dizziness46:11 PT/OT courses to build ED programs

47:37 Hands-on feedback for HINTS proficiency

#Dizziness #Vertigo #BPPV #HINTSExam #Stroke #EmergencyMedicine #VestibularRehab #PhysicalTherapy #POTS #OrthostaticHypotension #NeuroPT #TalkDizzyToMe