The EMSL now has remote SBIRT resources available. They are open Mon-Sat 10a-8p. They are available to help with any issues including prescribing naltrexone, referring patients, friends, family or yourself, and setting up a health coach.

This course offered this summer by Northwell offers training from combined societies – SHM (the Society of Hospital Medicine) and CHEST (pulm critical care). The directors Linda Kurian and Harald Sautoff are longstanding point of care educators who teach with the national SHM/CHEST courses. I’ve taught with this group and they know how to put on world class ultrasound education. This will definitely be worth it if you are looking for a local course.

The charge nurse should tell the provider to enter the “Ambulatory Referral to the Emergency Department Order” instead of using the expected patient workflow.  There are several benefits to using this order:

1. The sending provider does not have to call the ED – which they hate doing because they usually wait on hold until the charge nurse can pick up the phone. The sending provider can enter whatever information they want into the order (the workup they are requesting, when they want a call back, etc.)
2. Saves the charge nurse from having to pick up the phone and fill out the expected patient workflow – which is not going to get the provider the information that they need anyway.
3. This order generates an OPA that opens as soon as the provider opens the chart and stays in the chart for the whole encounter as a reminder for the provider to contact the PCP when the workup is done. 
4. There is also an icon that appears on a trackboard column that lets the providers know that someone put in this order for the patient.

The Optum docs can enter the order from EpicCareLink – which is what they use in their office.

• Leonard Park 1 Wallace Drive, Mount Kisco, NY
• Fox Senior Center 198 Carpenter Ave, Mount Kisco, NY
• Mount Kisco Public Library 100 Main St, Mount Kisco, NY

Westchester County Community Warming Centers (OPEN 24 HOURS)

• White Plains Samaritan House Shelter (WOMEN ONLY) 33 Church St, White Plains, NY (914)-948-5044
• Open Arms Shelter (MEN ONLY) 86 E Post Rd, White Plains, NY (914) 948-5044
• Yonkers Sharing Community 2 Hudson St, Yonkers, NY (914) 963-2626

For your next difficult access patient, you can review ultrasound guided iv access on the dedicated nwhed.org page.

EDCT Project – When Main CT is down as well

EDCT Project – Communicating with Phelps

Code Stroke – EDCT Project Plan

Code Stroke – No operational CT

Stroke MRI – MR Angio Brain WO IV Contrast (Epic Order, Details )

Vertigo can be difficult to diagnose correctly with BPPV being common and stroke / central vertigo much less common with intervention due to stroke even rarer. Confounding the prevalence issues are stroke mimics (benign etiology presenting as stroke) and chameleons (stroke presenting as benign etiology). The HINTs exam can be quite sensitive but can be difficult to perform correctly and is very user dependent. The neverending search for a better screening tool for further stroke evlauation lead the authors of the Sudbury Risk Score to near simultaneously publish their derivation and validation manuscripts.

Bottom line / Clinical Implications

The study authors tout the potential utility of the Sudbury Vertigo Risk, but do not suggest it is ready for clinical implementation. From the validation study manuscript:

If this score is prospectively validated in centers not included in the derivation cohort, the next step will be a consensus meeting. This meeting will need to include neurologists, radiologists, ED physicians, ENT surgeons, and patients. The goal would be to establish the most appropriate investigations and treatments at each serious outcome probability level.

It seems reasonable to incorporate this score in your thinking about your patient with vertigo, but there is no specific guidance that incorporates this score from hospital systems or EM clinical societies.

Limitations

• Both validation and derivation studies were conducted at large urban tertiary centers in Canada. This may not generalize well to your small community hospital in another country.
• There is no external validation — the validation study was a retrospective review of 6 years of patient information at the same institutions that performed the derivation. The authors mention this limitation.
• This score remains operator dependent — accurate scoring depends on a focused neurological exam; motor, sensory, and cerebellar deficits must be actively sought, or risk will be underestimated.

Study Inclusion/Exclusion

• Adults (≥18 yr) who present to an ED or urgent-care setting
• Within 14 days of onset of acute vertigo, dizziness, or imbalance.
• Patient is alert (GCS = 15)
• Patient is hemodynamically stable (SBP ≥90 mmHg)
• No recent head/neck trauma, syncope, or active cancer.

Risk Score Points Calculation

Interpretation

References

1. Kerber KA, Sangha N, Burke JF, Jancis MO, Baecker A, Shen E, Nguyen H, Monjazeb S, Manthena P, Park S, Sharp AL, Meurer WJ. Cumulative Incidence of Stroke Disability and Mortality Following Emergency Department Discharge for Dizziness: A Cohort Study. Ann Emerg Med. 2025 Nov 18:S0196-0644(25)01244-2.
2. MDCalc Sudbury Vertigo Risk Calculator