Vertigo - Epley manoeuvre from BMJ Learning

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• published: 06 Feb 2014
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http://learning.bmj.com This video is taken from a BMJ Learning module on Vertigo. http://learning.bmj.com/learning/module-intro/vertigo.html?moduleId=10016740 The Epley manoeuvre can also be diagnostically helpful because repeated treatment failures using the Epley manoeuvre may suggest that the provisional diagnosis of BPPV may be incorrect. You should explain the procedure to the patient, and warn them that they may experience vertigo symptoms during it, but that the symptoms usually subside quickly. You should ask them to keep their eyes open throughout. Check that the patient does not have any neck injuries or other contraindications to rapid spinal movements - you need to execute movements during the procedure rapidly (in less than one second) Ask the patient to sit on an examination couch with their legs extended, close enough to the edge so that their head will hang over the edge when they lie down Stand on the side of the affected ear, take hold of the patient’s head with both of your hands, and turn their head 45° towards you. Hold until nystagmus dissipates Keeping their head in that position, lean the patient back rapidly until their head is over the edge of the couch. Hold until nystagmus dissipates Rotate the patient’s head through 90°, away from the side of the affected ear. Hold until nystagmus dissipates. Ideally, the patient’s head should be below the horizontal at all points when it is turned Keeping their head steady with both of your hands, ask the patient to roll their body onto their side, away from the affected ear. While the patient is turning, turn their head a further 90°, so that it faces the floor. Hold until nystagmus dissipates While keeping the patient’s head turned to the side, help them to sit up. Hold until nystagmus dissipates With the patient sitting up, move their head into the centre line, as you move it forward 45° (chin on chest). Hold until nystagmus dissipates. Register with BMJ Learning to access over 100 free modules - or subscribe for as little as £35 a year to access the full catalogue. Collect your CPD points and certificates by visiting http://learning.bmj.com. Transcript There are a number of treatments and a number of manoeuvres to treat benign paroxysmal positional vertigo. However, the Epley manoeuvre is the most well established and it's the test that has proven to be successful in this condition. The first part of the Epley manoeuvre is essentially performing the Dix-Hallpike manoeuvre Once the head has been extended I always make sure that if a patient is feeling dizzy or I see some nystagmus, I wait for this to completely resolve before continuing to perform the next stage of the manoeuvre. The head is turned 90 degrees towards the opposite shoulder. This means that the head now lies 45 degrees relative to the vertical plane. You can relax your arms now. What I'd like you to do, in your own time, is to roll on to your left hand side and just let me support your head. Whilst the patient is turning, the head is rotated a further 90 degrees in the same direction. Finally, the patient is asked to sit up with her legs over the side of the couch. During this manoeuvre I like to take control of the head so that I can position it as I would like it to be. At the end of the manoeuvre I ask the patient to finish so that their chin is sitting nicely on their chest.