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Interviewer: All right, time to play along and see if you know the answer to today's "ER or Not" with emergency room physician Dr. Jeffrey Druck. Are you ready, Dr. Druck?

Dr. Druck: I am. Let's hear it.

The Scenario: Sudden Dizziness

Interviewer: All right. You're minding your own business and then suddenly you get really dizzy, like maybe even so much that you have to sit down. Seems very concerning, but the question is, ER or not?

Dr. Druck: Scot, that's a really tough one, and I think that that's really tough because, first of all, dizziness is really poorly defined, and, you know, we try and clarify whether it's dizziness in terms of like vertigo, like the room spinning, or whether it's lightheadedness. And I think that all of us have experienced vertigo and all of us have experienced that lightheadedness sensation, and there are a lot of different causes for both of those.

Serious Causes of Dizziness: Stroke, Blood Loss, Ectopic Pregnancy, and Arrhythmia

One of the things that we always worry about, when we talk about dizziness, is we worry about stroke, and one of those components is how seriously at risk for a stroke you are, like how old you are, whether you have a history of high blood pressure or other issues. But then there are other things that can cause lightheadedness also, so, for example, things like blood loss. So, for example, if you're having a GI bleed and you have blood in your stool, that can cause you to be lightheaded.

Similarly, we always worry about women who might not know that they're pregnant, that they could have an ectopic pregnancy or a pregnancy in the wrong location that can cause internal bleeding. Similarly, we worry about heart issues in terms of someone having an arrhythmia, and that arrhythmia causing them to feel lightheaded. So we really get concerned whenever someone says dizzy, and so it's really hard for me to tell people to stay home when they feel dizzy.

Non-serious Causes of Dizziness: Orthostatic Hypotension and Dehydration

Now, that being said, there can be a lot of things that are not so serious that also can cause dizziness, and those would be things like something called orthostatic hypotension, which is when you have too little fluid in your body from dehydration where you just haven't tanked up enough, and that you end up feeling really lightheaded whenever you stand up abruptly. And so those are the other things that, you know, we want to make sure that you don't have something serious and something life-threatening. So it's really a tough call from that perspective in terms of assuring people that they're going to be fine.

Assessing Risk Factors and Medical History

Interviewer: So how do you handle that? Like if a relative or a friend called you up and said, "I'm dizzy. Should I go to the ER or not?" Like that's the magic question, right? Like you said, it's difficult, but . . .

Dr. Druck: Yeah, I think that part of it is we start asking questions around what the circumstances were that had someone feel that way. So, for example, if somebody just stood up, then it's a little bit more likely that it's orthostatic hypotension. And we ask them those questions about other possible causes of bleeding or other things that might be arrhythmias, in terms of people having palpitations where they feel like their heart is racing. Similarly, we sort of do some risk stratification based on how old they are and what other medical problems they have. And so when I get a call from a family member that says, "Hey, I'm feeling really dizzy," I try and suss some of those things out and figure out which elements I'm concerned about.

Seek Emergency Care if Dizziness is a Worry

But if anyone is ever worried, and I think this goes for any concern that people have across the board, then we always say come to the emergency department. And, you know, we're there 24 hours a day, 7 days a week, 365 days a year to help people and to reassure people. And so people often sometimes say, "Boy, I'm really worried. You know, I don't want to waste your time." No one is ever wasting our time. We really want to reassure people and make them feel more comfortable in terms of coming in so that way they are able to leave with that sense of reassurance and know that things are going to be okay.

Interviewer: All right, final diagnosis, Dr. Druck. ER or not, "I'm feeling really dizzy"?

Dr. Druck: So unless you're dehydrated for some reason, in terms of just being out in the sun for a long time, or you just stood up and feel lightheaded and that passes fairly rapidly, then that might justify a trip to the emergency department.