What is the approach for a patient (Pt) working at heights with a history (hx) of dizziness?

From the Guidelines

For a patient working at height with a history of dizziness, I strongly recommend avoidance of work at heights due to the potential for serious trauma. This approach is supported by the Chest guideline and expert panel report from 2018 1, which advises avoidance of occupations working at height for individuals with conditions that may increase the risk of trauma.

Key Considerations

• A thorough medical evaluation is necessary to determine the cause of dizziness, including a history, physical examination, orthostatic vital signs, and possibly vestibular testing.
• Common causes of dizziness, such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Ménière's disease, medication side effects, orthostatic hypotension, or cardiac arrhythmias, should be considered and treated accordingly.
• Treatment depends on the specific diagnosis, and the patient should only return to height work after symptoms are controlled and with medical clearance.

Workplace Accommodations

• If the patient's condition cannot be adequately controlled, permanent reassignment to ground-level duties may be necessary to prevent serious fall risk.
• Other potential accommodations include a buddy system or additional safety harnesses, but these should not replace medical evaluation and clearance.

Prioritizing Safety

• The risk of fatal falls due to dizziness at elevation is a critical concern, and avoidance of work at heights is the most prudent approach until the patient's condition is fully assessed and managed.

From the FDA Drug Label

Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults (1). The FDA drug label does not answer the question.

From the Research

Approach for a Patient with a History of Dizziness Working at Heights

• The approach for a patient with a history of dizziness working at heights involves a thorough evaluation and management of the underlying cause of dizziness 2.
• The evaluation should include a timing-and-triggers approach to characterize the patient's vestibular symptoms as continuous or episodic 3.
• The patient's physical examination may include orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, the Dix-Hallpike maneuver, and the HINTS examination when indicated 2.
• Treatment for dizziness is dependent on the etiology of the symptoms, and may include canalith repositioning procedures, vestibular rehabilitation, or pharmacologic intervention 2, 4, 5.
• Vestibular rehabilitation has been shown to be effective in improving symptoms of dizziness, balance, and emotional status in patients with chronic dizziness 4, 5.
• For patients with benign paroxysmal positional vertigo (BPPV), a bedside test (Dix-Hallpike test) and treatment with a bedside positional (Epley) maneuver can be an efficient and effective management approach 6.

Considerations for Working at Heights

• Patients with a history of dizziness working at heights should be evaluated and managed to reduce the risk of falls and injuries.
• The treatment plan should take into account the patient's occupation and the potential risks associated with working at heights.
• Vestibular rehabilitation and other treatments should be tailored to the patient's specific needs and goals, including improving balance and reducing symptoms of dizziness 4, 5.