Trick of the Trade: Dix-Hallpike maneuver variation

The Dix-Hallpike maneuver is used to help diagnose benign paroxysmal positional vertigo (BPPV).

Place the gurney’s head of the bed down flat.
Reposition the patient so that s/he is sitting another 12 inches or so closer towards the head of the flat gurney.
Rotate patient’s head 45 degrees.
Help the patient lie down backwards quickly.
The patient’s head should be hanging off of the gurney edge in about 20 degrees extension.
Observe for rotational nystagmus after a 5-10 second latency period, which confirms BPPV.

I find 2 things challenging in this maneuver.

The patient often does not like to be moved AT ALL while feeling nauseously vertiginous. This even includes trying to reposition the seated patient closer to the head of the bed. This requires them to look behind them to see what where they are going, which sets off more vertigo.
In some of our ED rooms and hallways, the head of the gurney bed is often abutting a wall, a portable monitor, or some equipment. It takes a little fancy shuffling to make room for the Dix-Hallpike maneuver.

Trick of the Trade: A modified Dix-Hallpike maneuver

Place blankets or a pillow under the shoulders for the Dix-Hallpike maneuver.

The key is to maintain about 20-30 degrees of neck extension to align the posterior semicircular canals with the direction of gravity. Placing several blankets under the patients’ shoulders can accomplish this same position without having to scoot the patient close to the gurney edge. I’m sure the patient would appreciate keeping their head movement to a minimum.