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EMSWORLD.com | APRIL 2016 49 TABLE 2: CONTINUED Vertigo General description—Characterized by a spinning or rocking sensation provoked by movement of the head. Keeping the head still improves symptoms. Symptoms are usually intermittent, and intensity waxes and wanes. Onset—Abrupt onset, usually intermittent or waxing and waning. Palliative/provocative/previous—Change in position worsens, remaining still improves. Quality—Spinning or rocking sensation often associated with motion sickness and nausea. Radiation/region—Generalized spinning. Severity—Can be severe with intractable vomiting and vertigo, milder if remains still. Timing—Sudden onset can improve over hours with treatment. Associated—Nausea, vomiting, ringing in ears (tinnitus). Todd's Paralysis (seizure) General description—Unilateral extremity weakness or paralysis that occurs after a seizure. Paralysis typically last minutes to hours, but can last up to 48 hours. Onset—Onset following a seizure. Palliative/provocative/previous—None. Quality—Unilateral weakness of an extremity following a seizure. Radiation/region—One-sided extremity. Severity—Generally complete paralysis initially resolving in 48 hours. Timing—Onset after seizure, may persist for up to 48 hours. Associated—N/A. Meningitis General description—Infection of the meninges. Typically occurs in communal-type living (military barracks, college dorms). Initial symptoms are similar to infuenza. Consider meningitis for patients with fever, severe headache and nuchal rigidity; however, only about 45% of patients have all three classic symptoms. Onset—Gradual over hours. Palliative/provocative/previous—Increased neck pain with fexion. Quality—Flulike symptoms: fever, head and body aches, AMS. Radiation/region—General body aches and headache, nuchal rigidity. Severity—Depends on the cause. Viral meningitis is self-limiting, bacterial meningitis is life-threatening. Timing—Gradual onset but rapid deterioration. Associated—Nuchal rigidity, AMS (irritability or lethargy), seizures, coma, photophobia, vomiting and rash (petechia). Finger to nose—This test assesses a patient for loss of coordination and dysmetria, a type of ataxia where the ability to judge distance and speed is impaired. If the patient can- not correctly judge distance and reaches too far or not far enough, the test is posi- tive for dysmetria. Also, if the patient can accurately touch their nose on one side but not the other, it is a positive test for focal cerebellar dysfunction. To perform the exam, stand in front of the patient. Have the patient touch their nose with their index finger, and then have them touch your finger. Have the patient alter- nate back and forth between touching their nose and your finger several times. Then move your finger to different locations. You must be far enough away so the patient has to fully extend their arm in order to touch your finger. Have the patient repeat with the opposite hand. Heel/shin—Have the patient place the heel of one foot on the knee of the opposite leg. Instruct the patient to slide the heel in a straight line down to the foot and back up to the knee several times. Repeat on the other side. If there is a difference in how well a patient can keep their heel on their shin on one side versus the other, it is considered an abnormal test. Motor Function This tests the circulation pathways of the anterior brain. Hemiparesis is defined as unilateral mus- cular weakness. Patients can still move the TABLE 3: PAST MEDICAL, SOCIAL AND FAMILY HISTORY Ischemic Stroke PMHx—HTN, a-fb, diabetes, previous stroke or TIA all increase risk of stroke. SocHx—Smoking, excessive alcohol. FHx—FHx of stroke increases risk. Hemorrhagic Stroke PMHx—N/A. SocHx—Cocaine, excessive alcohol. FHx—FHx of cerebral aneurysm or hemorrhagic stroke increases risk. TIA PMHx—HTN, a-fb, diabetes, obesity all increase risk of TIA. SocHx—Smoking, excessive alcohol. FHx—FHx of stroke increases risk. Bell's Palsy PMHx—Diabetes, autoimmune diseases, Lyme and other infections are associated with increased risk. SocHx—N/A. FHx—FHx of Bell's increases risk. Vertigo PMHx—Meniere's, prior episodes of vertigo. SocHx—N/A. FHx—FHx of vertigo increases risk. Todd's Paralysis (seizure) PMHx—Seizures. SocHx—Drug withdrawal increases seizure risk. FHx—FHx of seizures increases risk. Meningitis PMHx—Lack of vaccination to meningitis. SocHx—Communal living such as college dorms or army barracks increases risk. FHx—N/A. A ssessing for cerebellar function can help identif y less-common posterior circulation strokes.