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By Michelle Lin
Medical Doctor
Specialty: Emergency Medicine
Blog: http://academiclifeinem.blogspot.com
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Michelle Lin's Twitter Updates

@precordialthump I totally forgot about the EKG library! Awesome stuff. Keep up the great work (when do you sleep?!) 258 days ago
@emeducation Perfect, thanks for the suggestions! Turns out one is co-authored by Jeff Tabas. He already gave them all books. 258 days ago
Recommendations for an EKG resource to review bread & butter cases for senior residents? Pre-graduation panic setting in for our residents. 258 days ago
@danipedia Good point. I use the studies to convince the trauma consults NOT to get c-spine imaging on EVERYONE (citing distracting injury)! 263 days ago
@doctorflash Hi there. Just wanted to drop a note to thank you for all the extra traffic you're sending to blog. Much appreciated!! 273 days ago
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Trick of the Trade: Dix-Hallpike maneuver

Posted Aug 30 2011 12:00am

The Dix-Hallpike maneuver is used to help diagnose benign paroxysmal positional vertigo (BPPV). 
  • Place the gurney's head of the bed down flat. 
  • Reposition the patient so that s/he is sitting another 12 inches or so closer towards the head of the flat gurney. 
  • Rotate patient's head 45 degrees.
  • Help the patient lie down backwards quickly.
  • The patient's head should be hanging off of the gurney edge in about 20 degrees extension.
  • Observe for rotational nystagmus after a 5-10 second latency period, which confirms BPPV.
I find two things challenging in this maneuver. 
  • The patient often does not like to be moved AT ALL while feeling nauseously vertiginous. This even includes trying to reposition the seated patient closer to the head of the bed. This requires them to look behind them to see what where they are going, which sets off more vertigo.
  • In some of our ED rooms and hallways, the head of the gurney bed is often abutting a wall, a portable monitor, or some equipment. It takes a little fancy shuffling to make room for the Dix-Hallpike maneuver.



Trick of the Trade:
Place blankets under the shoulders for the Dix-Hallpike maneuver

The key is to maintain about 20-30 degrees of neck extension to align the posterior semicircular canals with the direction of gravity. Placing several blankets under the patients' shoulders can accomplish this same position without having to scoot the patient close to the gurney edge. I'm sure the patient would appreciate keeping their head movement to a minimum.

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