Benign positional vertigo: recognition and treatment. The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial. Intravenous Lorazepam versus dimenhydrinate for treatment of vertigo in the emergency department: a randomized clinical trial. In a real patient, each position should be held for at least 30 seconds or until resolution of the nystagmus and vertigo. Keep the patient in this position for at least 30 seconds or until the nystagmus or symptoms resolve. Again, observe for nystagmus and hold this position for at least 30 seconds or until nystagmus or symptoms resolve. Again, wait for at least 30 seconds. Each position should be held at least 20-30 seconds. 6. Inspect the patient’s eyes carefully for evidence of nystagmus for at least 30 seconds. Observe the patient’s eyes and look for torsional nystagmus. The thumb can be used to help keep the eyelids open since noting the direction of the nystagmus is important.
Epley maneuver. Turn the patient’s head 90° in the opposite direction (in this case, the patient’s head is now facing to the right). Maintaining the head at 45°, the head is raised to the fully upright position. 5. Maintaining the head at 45°, the head is raised to the fully upright position. Epley maneuver. The patient is now sitting upright. Epley maneuver. Ask the patient to turn onto his or her shoulder. Bar-b-que maneuver. This maneuver is used to treat horizontal canal benign positional vertigo. In this example, the right horizontal canal is being treated. Epley maneuver. In this example, the left posterior semicircular canal is being treated. Hallpike test. In this example, the right posterior semicircular canal is being tested. Epley maneuver. Turn the patient’s head 45° to the side that had the most prominent symptoms during the Hallpike test. Epley maneuver. Because the patient’s head will be turned 90° in the other direction, the physician needs to move to the head of the gurney and regrip the patient’s head so that the fingers are pointing toward the patient’s feet. Semont maneuver. Generally reserved for the cupulolithiasis form of benign positional vertigo, in which the otoliths are attached to the cupula of the semicircular canal.
The Epley maneuver is positional, not positioning. Epley maneuver. Guide the patient’s head down so that he or she is looking at the ground. With both hands holding the patient’s head, gently lay the patient down in the supine position with the head hanging over the edge of the bed. Epley maneuver. The patient’s head should be at 45° and hanging off the edge of the bed. Note that the head extends over the edge of the gurney. Then, the patient needs to sit up with the legs hanging over the side of the gurney (which is why the guardrails need to be lowered before the start of the procedure). Note: Each maneuver does not need to be performed rapidly. This maneuver has to be performed rapidly to be effective, and it is not recommended in elderly persons. In this clip, the maneuvers are performed quickly. Size 3: The size 3 balls are the smallest of the three balls that are meant for official use.
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