Management/Diagnostic Testing If active bleeding or fresh clot is identified, immediately call for otolaryngology evaluation If profuse bleeding is encountered, obtaining a hemoglobin level or hematocrit is reasonable as is a type and cross for matching potential transfusion Note that obtaining a blood concentration prior to adequate resuscitation will result in falsely elevated levels Adequate pain control with judicious use of narcotic analgesics is important Nonsteroidal analgesics (NSAIDs) should be avoided in any patient with active bleeding Clinical Indication for Discharge or Admission For all PTH patients who not require operative intervention, criteria for admission for observation will vary by institution For nearly all patients, however, any history of bleeding from the oral cavity should be admitted for observation VERTIGO Goals of Treatment Sudden vertigo is a disturbing and often confusing symptom Vertigo caused by middle ear pathology is often accompanied by nausea, vomiting, imbalance, and irregular gait Correctly identifying more serious etiologies of vertigo is an important goal of treatment Vertigo may result from dysfunction of any part of the vestibular system (from the labyrinth to the vestibular cortex), and may be associated with a number of conditions affecting the middle ear Hearing loss is commonly associated with concerning etiologies of vertigo and should be evaluated during the visit CLINICAL PEARLS AND PITFALLS Vertigo is a symptom of underlying disease, and evaluation should always involve looking for the etiology as well as providing symptomatic treatment Hearing loss often accompanies serious etiologies of vertigo Vertigo in the setting of trauma should raise concern for a serious intracranial etiology and prompt additional evaluation Vertigo, the perception that the environment is inappropriately moving relative to the patient or that the patient is moving relative to the environment, can be