![]() The wound will need to be thoroughly irrigated at a later stage. If this is not controlling the bleeding, consider temporary closure with staples or suturing. Lacerations can bleed profusely control bleeding with direct pressure and bandaging. If a penetrating object remains lodged, do not remove it. Gently palpate for any depressions or irregularities in the skull. Do not probe the scalp and be cautious when examining as bone fragments and fractures may be present. Image used with permission from Jeffery Rosenfeld, Practical managment of head and neck A detailed neurological examination forms an important part of the secondary survey and can assist with guiding management and assessing the need for transfer. Opens eyes in response to painful stimuliĮxtension to painful stimuli (decerebrate response)Ībnormal flexion to painful stimuli (decorticate response)ĭuring this examination, any injuries detected should be accurately documented and any required treatment should occur, such as covering wounds, managing non-life-threatening bleeding and splinting fractures. Top of page Glasgow Coma Scale Best response A difference of greater than 1 mm is considered abnormal.ĭocument the findings on the observation chart and reassess frequently. ![]() Note if the reaction is brisk, sluggish or unreactive. Pupils should be examined for their response to light and their symmetry. Note whether the patient is agitated or combative. Differing levels of GCS determine the severity of the TBI, as mentioned earlier. Limb response to commands or painful stimulation is used to detect asymmetry between the right and left sides. The best eye opening, verbal and motor response is taken and given a score out of 15. It is the universally accepted gold standard for assessing disturbances in a patient’s conscious state in the adult population. ![]() Past medical history including tetanus statusĮvents leading to injury 11 Neurological assessmentĪssess the patient’s level of consciousnessĪ baseline GCS should be taken to accurately assess the patient’s neurological status. Medication (especially anticoagulants, antiplatelet agents etc.) ![]()
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