In this video, you will get to watch the neurologic exam of a patient. This exam is primarily designed to identify patients with a problem with some portion of their nervous system. The emphasis will be on the maneuvers to identify a stroke early. That said, a neurologic exam will also allow you to identify patients at risk of falling or who have subtle findings of altered mentation. Let's begin watching as the EMT approaches the patient and begins their assessment. Assume that they have already checked that the scene is safe and put on appropriate personal protective equipment. >> Hi, what's your name? >> I'm Ellie. >> My name's Tyler, I'm a paramedic. >> By asking the patient their name you can easily start to assess if the patient can identify themselves and get a sense of their mental status, as well as their speech. We will fast forward in this encounter to the specific portions of the neuro exam. Throughout your assessment, pay attention to if the patient is able follow the commands or, are you having your work to coach them through the tests. First, you will assess the phase. Look for any signs of asymmetry in the smile or other facial muscles. If you aren't sure if what you see is normal, you can ask a family member or even show the patient themselves in your phone. >> Hi, can you smile for me? Good, now, can you raise your eyebrows? Good, after accessing the face, you'll assess for weakness. The easiest way to do this is to have the patient move their arms. >> So I'm going to have you raise your arms up, where I place them like you're almost holding a big bowl of soup. Close your eyes and hold them there until I say otherwise. Good, next I'm going to have you squeeze my fingers as hard as you can with each hand. I need to see how strong you are when you squeeze. So next, we're going to assess your legs. I'm going to straighten this leg here and then one by one, we're going to lift and hold this leg off the ground, good. Good. >> In this particular exam maneuver, you are looking to see if the patient can raise up both arms equally and if their grip strength is equal on each side. Before jumping to the assumption of a stroke, it might be worth asking the patient if either of these findings are from prior injuries. If not, you should be concerned for a stroke. If they are in a position where it is possible, you can do similar tests with the legs. Next, you will formally assess the patient's speech and thought process. You might have a specific phrase you have them say, or items you have them identify. >> So, I'm going to ask you to repeat the phrase after me. The sky is blue in Cincinnati. >> The sky is blue in Cincinnati. >> Very good. What type of object is this? >> It's a watch. >> And, what type of object is this? >> A pen. >> Good. >> As you move the patient to the ambulance, your final assessment is their gate. You can have them walk to a point or just watch how they move getting into the stretcher. Are they wobbly or unsteady? Are they able to stand on their own? >> Okay, so now I'm going to help you stand up and we're going to walk to the ambulance. >> If at any point the patient fails these measures, they likely need to be transported to a hospital with lights and sirens and possibly need ALS care if it is available and won't delay care. You might wonder how this neuro exam fits with the stroke scales. The goal of the stroke scale is to help you quickly identify a patient that might be having a stroke. A neuro exam like this will also allow you to do the same thing, and then use the information you gather to calculate the stroke scale based on whatever scale your system uses. For example, if the patient above had a facial droop, but everything else was normal, his Cincinnati stroke scale would be one.