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For the heel/shin test of cerebellar function, have the patient place the heel of one foot on the knee of the opposite leg, then slide the heel in a straight line down to the foot and back up to the knee several times. Lew Steinberg EMSWORLD.com | APRIL 2016 51 were first recognized. With a "wake-up stroke," the time last known normal may be when the victim went to bed the night before or got up during the night to use the bathroom. If this information is not readily available, the phone number of a witness should be obtained to transmit to the hospital staff. Without having the last- known-normal time, the patient may not be eligible to receive some of the available stroke treatments. Ischemic stroke/TIA is characterized by a sudden onset of any combination of dif- ficulty with speech, focal motor or sensory function, confusion, visual disturbances, difficulty with coordination or ataxia (unsteady, staggering gait). History may include prior stroke/TIAs, hypertension, a-fib, smoking, excessive alcohol consump- tion or family history of stroke/TIA. 4 TIAs present with the same signs and symptoms as an ischemic stroke, but symp- toms typically last less than five minutes and no more than 24 hours. TIAs do not cause permanent brain damage, as the blockage is only temporary. However, because stroke symptoms may come and go early in their course, even if a patient improves, the authors feel a "stroke alert" should still be called, since problems may recur. What may initially look like a TIA may worsen and become a large stroke. Differential diagnosis: Hypoglycemia, migraine headache, seizure (Todd's paraly- sis), vertigo, meningitis, head trauma. Hemorrhagic stroke—This typically presents with a sudden onset of severe ("thunderclap") headache, often described as the worst of one's life. It may be associated with an altered mental status, vomiting, focal neurological defi- cits, seizure and coma. As bleeding continues, the patient may show signs of herniation syndrome: unresponsive- ness, blown pupil, vomiting, Cushing's triad (bradycardia, hypertension and an altered breathing pattern). MACS is Making Ambulance Crews Safer with the Mac's Bariatric Ambulance Lift. With a 1,300 lbs. weight capacity the lift is prepared for any job you can roll on it. The platform 800-795-6227 sales@macsliftgate.com www.macsliftgate.com is universal and will accommodate whatever equipment you choose to use. The Bumper Stow Technology makes the lift available to the ambulance crew at all times and functions as a bumper and step. Don't Strain Your Back... Go See Mac! For More Information Circle 38 on Reader Service Card