- Total Evaluation of Patient
- Head and skull (including ears and oral cavity)
- Maxillofacial injuries
- Complete neurological examination
- Appropriate x-rays, laboratory tests, and special studies
- "Tubes and fingers" in every orifice ie PV / PR.
- O2 saturation
- Core temperature
- Urinary catheter
- Gastric tube (Oro-gastric NOT Naso-gastric if head / facial injuries)
- Cervical spine lateral initially and ensure C7 and Tl are visualised.
- Erect CXR
- ABG - Remember acidosis is a sensitve indicator of the effectiveness of resuscitation. Repeat frequently.
- X match
- UEC, LFT, AMY
- Blood Glucose
- Head Trauma Q
- TBI may be divided into 2 broad categories, closed head injury and penetrating head injury.
- The Glasgow Coma Score (GCS) is used to describe the level of consciousness of TBI patients.
- The GCS is divided into 3 categories, eye opening (E., motor response (M), and verbal response (V).
- The score is determined by the sum of the score in each of the 3 categories, with a maximum score of 15 and a minimum score of 3, as follows:
|4||Withdraws from stimulus||Confused||Spontaneously|
|3||Flexes arm||Words/phrases||To voice|
|2||Extends arm||Makes sounds||To pain|
|1||No response||No response||Remain closed|
GCS = E + M + V: E + M + V = 3 to 15
Generally, the GCS:
- For severe head injury is 9 or less;
- for moderate injury, 9-12; and
- for minor injury, 12 and higher.
In a patient with head injury, eye opening is seen with painful stimulus, there is appropriate verbal response to pain, and patient can localize the pain. What would be his GLASGOW COMA SCALE (GCS) score? (AIPG 2011)
Ans. B. 10.