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DIZZINESSRecognise the patient with dizziness needing urgent attention:• Dehydration due to vomiting/diarrhoea (systolic BP drop ≥ 20mmHg between lying and standing) with poor response to IV or oral rehydration• Consider stroke if sudden onset of dizziness is associated with vision problems, weakness on 1 or both sides, difficulty speaking or swallowing 76.• BP < 90/60• Pulse < 40 and/or irregularManagement:• Refer same day to hospital.Approach to the patient with dizziness not needing urgent attention• Ask about ear symptoms. If present 12.• Screen for substance abuse: if > 21 drinks/week (man) or > 14 drinks/week (woman) and/or > 5 drinks/session or misuse of illicit or prescription drugs 83.• Review patient’s medication. Anti-hypertensives, sedatives, efavirenz, oral hypoglycaemics, anti-convulsants can all cause dizziness. Refer to doctor.• If diabetic, check finger prick blood glucose for hypoglycaemia 71.• Check for anaemia with Hb. If < 11 (woman) or < 12 (man), refer doctor same week.• Check BP. If > 130/80 73 to interpret result. Assess for postural hypotension: Measure BP lying and repeat after standing for 3 minutes.Systolic BP drops ≥ 20mmHgbetween lying and standingPostural hypotension likely• This is common if elderly or pregnant93.• Advise patient to stand up slowly.• Doctor must review if patient on anymedication.YesHyperventilation likely• Advise re-breathing into a brownpaper bag.• Assess and manage patient’s stress52.No drop or drop in systolic BP < 20mmHgAsk patient to breathe rapidly for 2–3 minutes. Are symptoms reproduced?Dizziness precipitated by sudden headmovementsPositional vertigo likely• Patient needs Epley manoeuvre. Referto doctor.NoAsk about associated featuresRecent flu-like illnessVestibular neuronitis likely• Mobilize as soon as possible.• Refer to ENT if:--Symptoms > 2 weeks--Tinnitus--New deafness• If none of the above, check TSH. If abnormal, refer to doctor.• Refer if no cause is found or dizziness persists.8TB HIV CHRONIC RESPIRATORYDISEASECHRONIC DISEASESOF LIFESTYLEMENTAL HEALTH EPILEPSY MUSCULOSKELETALDISORDERSWOMEN'S HEALTH