Dizziness/Imbalance

Availability

North South North West Statewide

Pre-referral work-up

History

All referrals should comply to referral standards and include in particular:

  • Rapidity of onset
  • Postural instability
  • Associated falls/injury
  • Driving status and any incidents
  • Palpitations, chest pain or breathlessness – possible cardiac presyncope
  • Co-morbidities and medications
  • * Chest pain, palpitations and breathlessness with presyncope/syncope
  • * Abnormal neurological examination
  • * >5 medications
  • Examination:
    • Postural BP
    • Presence of nystagmus +/- positive hallpike manoeuvre
    • Presence of neurology – myopathy with proximal weakness, hemiplegia, hyperreflexia
    • Cardiac murmurs or signs of heart failure

Tests

  • FBC
  • U&ECr
  • Calcium, Magnesium and Phosphate
  • ECG

Interim/GP management

To refer a patient with this condition, please see the General Medicine clinic page for the full referral process and templates.

The presence of (*) could indicate a serious cardiac condition. Consider phoning the General Physician on-call.

If an older patient requires input from a multidisciplinary team, we recommend referral to the Geriatrics Service based at the Repatriation Site.

For more information please see the Tasmanian Health Pathways website.

Emergency

Sudden onset suggestive of cerebrovascular aetiology (stroke)

Acute onset resulting in inability to self-care due to symptoms-major safety issues in home environment

Urgent / category 1

Chest pain palpitations

Abnormal neurological examination

Rapid onset and progression

Routine / category 3

Symptoms over years (please consider if referral is really necessary)

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

If there is an issue of cognitive function, please ask patients family/carer to attend the appointment.

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405  Fax: (03) 6348 7382
MCH ED – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED – Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED - Phone: (03) 6166 6100  Fax: (03) 6173 0489

Urgent:

We will endeavour to see these patients within two weeks.

Please contact the General Medicine Consultant on-call if you have an urgent case to be reviewed. All referrals viewed by Consultant and allocated to Consultant or Unit Registrar. Registrar cases will be discussed with Consultant.

Semi-urgent:

We will endeavour to see these patients within eight weeks

Routine:

Next available appointment