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EMSWORLD.com | APRIL 2016 53 History may include a recent viral illness or ringing in the ear. Differential diagnosis: hypoglycemia, migraine headache, stroke. Meningitis Consider meningitis in patients with a fever, nuchal rigidity (impaired neck flexion due to muscle spasm) and headache, espe- cially if associated with an altered mental status (lethargy, confusion and coma) or other neurological deficits. Additional symptoms include petechial rash, photophobia, vomiting and seizures. History: flulike symptoms (fever, head and body aches). Differ- ential diagnosis: stroke, migraine headache. Conclusion Now that we have reviewed the neurological history and physical exam, let's apply it to our patient complaining of dizziness and weakness. Using the pit crew method, your team has a member preassigned to immediately perform a Cincinnati Prehospital Stroke Scale on the patient, and it is found to be completely normal. After reading this article, you know many strokes are not detected by the standard prehospital stroke screens, so your team proceeds to do a more detailed neurological history and physical exam. You learn that what the patient calls "dizziness" to her means loss of balance. The onset was sudden, about an hour ago, and has not improved. It is worse if she tries to walk. There are no alleviating factors. She has a past history of TIA and a-fib. She has no headache. You and your team perform a full neurological exam and notice the patient has equal strength, sensation and cranial nerve function bilaterally. However, when you perform the finger-to-nose and heel- to-shin tests, you note the patient seems to have loss of coordination on the right side of the body. Based upon this information, you call a stroke alert and transport the patient to the nearest comprehen- sive stroke center. There doctors inform you the patient is having a posterior circulation stroke involving the balance center of the brain and will be taken emergently to the brain cath lab for treat- ment. You and your team have just saved another life. R E F E R E N C E S 1. Studnek JR, Asimos A, Dodds J, Swanson D. Assessing the validity of the Cincinnati prehospital stroke scale and the medic prehospital assessment for code stroke in an urban emergency medical services agency. Prehosp Emerg Care, 2013 Jul–Sep; 17(3): 348–53. 2. Berkhemer OA, Fransen PS, Beumer D, et al.; MR CLEAN investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med, 2015 Jan 1; 372(1): 11–20. 3. Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med, 2015 Jun 11; 372(24): 2,285–95. 4. National Stroke Association, www.stroke.org. A B O U T T H E A U T H O R S Kenneth A. Scheppke, MD, is the EMS medical director for six fire-rescue agencies in Palm Beach County, FL. He is also the assistant medical director of the JFK Medical Center emergency department in Atlantis, FL. Keith Bryer , BBA, EMT-P, is deputy chief of operations for Palm Beach Gardens Fire Rescue in Florida. For More Information Circle 40 on Reader Service Card 888-458-6546 3121 Millers Lane Louisville, KY 40216 Tel: 502-775-8303 Fax: 502-772-0548 S A F E T Y A P P L I A N C E C O M P A N Y www.junkinsafety.com PROUDLY MANUFAC TURED IN THE USA JSA-365 Plastic Backboard Specifcations Dimensions: 72" L x 16" W Load Capacity: 400 lbs. Shipping Weight: 16 lbs. Color: Bright Yellow Rugged one piece lightweight polyethylene spineboard with twelve large hand holes for easy handling and built in runners. It has a low profle and is X-ray translucent. The Model JSA-365-S Plastic Backboard with speed clip pins is also available. JSA-365 As frst-responders, you know keeping your cool can be a matter of life or death, and that's why you can rely on Engel. The Engel fridges are designed to meet the needs of the EMS market for the transport of temperature-sensitive saline and medications. For those long shifts, introducing our new vacuum insulated, high performance 30oz Tumbler - your partner in cool. l b t t f Phone 561-743-7419 • e n g e l c o o l e r s . c o m A LEGEND IN RELIABILITY For More Information Circle 41 on Reader Service Card