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ASSESSMENT TIPS The medics decide that the differential diagnoses are stroke and Bell’s palsy (caused by a disturbance of cranial nerve VII, the facial nerve). They remember that Bell’s palsy presents with paralysis that includes the entire face on the affected side, including the forehead and lower aspect of the face. Stroke patients are typically able to move their forehead muscles and arch their eyebrows; Bell’s palsy patients are not. The medics relate their findings to online medical control, who agrees with them that their patient is most likely experiencing Bell’s palsy. They transport normal traffic to the ER, where the physician confirms their findings. She is sent home for follow-up with her personal physician. Conclusion Conditions involving the head and neck can be life-threatening or relatively benign. Bell’s palsy usually resolves within 8–12 months without treatment. Current thinking is that it may be caused by herpes simplex virus (HSV), but not all agree. Cases like this can be challenging, and you must always consider the worst-case scenario of stroke or bleeding into the brain. However, the savvy medic who can distinguish stroke presentation from Bell’s palsy can make the difference between calling a stroke alert and a normal transport. Patients with either stroke or Bell’s palsy may be terrifi ed by what is happening to them. You can do a lot to alleviate stress by explaining things to the patient. If unsure about the cause of symptoms, err on the side of caution. It is better to occasionally call a stroke alert unnecessarily than to not call one when a stroke is present. For a good overview of Bell’ palsy, see http://emedicine.medscape.com/ article/1146903-overview#a0101. REFERENCE 1. Much of the information for this article is taken from Jarvis C, Physical Examination and Health Assessment 3rd edition, pp. 267-296, Philadelphia, PA: W. B. Saunders, 2000; Bickley LS, Bates’ Guide to Physical Examination and History Taking, Lippincott Williams & Wilkins Publishers, 2002; DeGowin’s Diagnostic Examination, ibid; and Seidel HM, Ball JW, Dains JE, Flynn JA, Mosby’s Guide to Physical Examination, St. Louis, MO: Mosby Elsevier Publishers, 1999. Emergency Vehicle Seating (800)364-3218 · International (574)233-5707 E-mail: evssales@evsltd.com · www.evsltd.com Our only business is seating safety for the EMS industry! For More Information Circle 38 on Reader Service Card EMSWORLD.com | JULY 2011 William E. (Gene) Gandy, JD, LP, has been a paramedic and EMS educa- tor for over 30 years. He has imple- mented a two-year associate’s de- gree paramedic program for a community college, served as both a volunteer and paid paramedic, and practiced in both rural and urban settings. He lives in Tucson, AZ. Steven “Kelly” Grayson, NREMT-P, CCEMT-P, is a critical care paramedic for Acadian Ambulance in Louisiana. He has spent the past 14 years as a fi eld paramedic, critical care trans- port paramedic, fi eld supervisor and educator. He is the author of the book En Route: A Paramedic’s Sto- ries of Life, Death, and Everything In Between, and the popular blog A Day in the Life of An Ambulance Driver. Follow the Leader in Seating Safety & Innovation Since 1993, EVS Ltd. has created more safety seating products than any one else in the EMS industry, by investing in research and development and dynamic testing. Introducing the EVS1860 Flip Up Seat: • Hi-Bac Child Safety Seat / Attendant Seat • Seat can be swiveled and stowed flat against the wall when not in use • Base may be mounted in 3 different locations • Easy-to-use cable release with 8 positions • Seamless construction :DWFK IRU RWKHU QHZ (96 SURGXFWV ² OLNH WKH 0RELOLW\ 7UDFNLQJ V\VWHP Shown center mounted. Seat can also be mounted to base on left or right side. Keep your EMT safe! Specify EVS’ advanced integrated restraint systems! 39 IMPROVED DESIGN NEW & NE