EMS Reruns is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we’ll pay you $50. Send ideas c/o Nancy.Perry@cygnusb2b.com.

It’s Friday night and you should have been off duty half an hour ago. You and your partner are supposed to meet your spouses for dinner, and you’re on your way to quarters when you get a call for a woman down, post-fall. You did not get lunch and you’re wishing you could get out of this, but there’s no way. It’s four miles to the station, you’re right on top of the call, and nobody else is even close.

You enter a two-story, single-family dwelling and follow a nervous 12-year-old girl up a single flight of stairs to a front bedroom where you encounter a 40-year-old woman wedged between a double bed and a wall. She’s lying on a hardwood floor, and she’s silent. The girl indicates that her mom had complained of a severe bifrontal headache an hour earlier, had taken some Tylenol and gone upstairs to lie down. She says she called 9-1-1 when she heard a loud thump and ran upstairs to find her mom unresponsive to anything. She says her mom has been healthy and has no history of diabetes, seizures or fainting spells, but has been having headaches and double vision for the past few months.

An engine company arrives and together you stand the bed against the opposite wall to clear some space. Your findings reveal a well-developed woman in early middle age with deep stertorous respirations of 15, who does not respond to her name, but who moans when you insert a nasal airway. Her skins are normal, and she has a one-by-four-inch linear abrasion on her right parietal scalp. Within a couple of seconds after you insert the airway, she localizes it and tries to retract it with the fingers of her right hand.

Q. What do you think is going on with this lady?

A. Whatever it is doesn’t sound good, does it? She needs a thorough neurologic assessment (including a CAT scan), but that history of headaches and diplopia really suggests a brain tumor.

Q. We know this lady has fine motor control over the fingers of her right hand. Is there an easy way to assess the function of her other hand?