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To test for isolated strokes in the visual cortex of the brain or retina, face the patient and have them focus on your nose while they cover one eye with a palm. Hold one or two fingers up to both sides of the patient's face. Ask the patient to identify how many fingers you're holding up. Lew Steinberg 44 APRIL 2016 | EMSWORLD.com Y ou and your crew are dispatched to the home of an elderly woman who complains of weakness and dizziness. On arrival you find a single patient lying on a couch. She is awake and can answer questions. Now comes the hard part: How do you determine if this patient is just a little dehydrated, didn't get enough sleep, or has a viral illness, vertigo, a heart attack or an acute stroke? Is this case a load-and-go or stay- and-play? In this second installment of our multipart series, we examine how to perform a neurological history and physical exam. Neurological emergencies pres- By Kenneth A. Scheppke, MD, & Keith Bryer, BBA, EMT-P Neuro emergencies can come with a wide variety of symptoms— here's how to narrow things down This is the second of a four-part series that appears bimonthly. Find Part 1 at EMSWorld.com/12149999. ent with a variety of symptoms. The ability to dif- ferentiate between them is necessary to determine a prehospital diagnosis with differential. Conducting a systematic neurological H&P; will provide enough information to quickly and accurately make a deter- mination regarding your patient care. Included in this article is an introduction to the "pit crew" approach to prehospital medicine. Using the pit crew approach helps organize the prehospi- tal crew into an efficient team with clear division of labor toward an overall goal of rapidly assessing, diagnosing, stabilizing and transporting the patient. Neurological H&P; When assessing patients with neurological com- plaints, it is imperative to conduct a thorough baseline exam as soon as contact is made. Patients with neu- rological emergencies may have their mental status rapidly deteriorate, making it more difficult to assess for a stroke or gather reliable information that may assist in making a diagnosis. The goal is to complete both the history and physical exam within 3–5 minutes. This will vary depending on the patient's chief complaint and mental status. As always, patient stabilization and transport should not be delayed to conduct a lengthy history and physical exam. A patient's mental status is the most reliable indica- tor of brain function, so when there is altered mental status, obtaining a history and assessing for cerebellar function, weakness and paresthesia becomes far more difficult. For these patients observation, soliciting