- Airway – talking, swallowing, gag reflex
- Breathing – ventilation and oxygenation – mentation and O2 saturation. Examine breathing pattern (Kussmaul, Cheyne-Stokes)
- Circulation – peripheral circulation, feel pulses, capillary refill
- C spine – mechanism of injury? Obvious facial lacerations/contusions
- Disability: pupils – equal and reactive? If no, consult neurosurgery!
* Best Eye Response. (4)
- 1. No eye opening.
- 2. Eye opening to pain.
- 3. Eye opening to verbal command.
- 4. Eyes open spontaneously.
* Best Verbal Response. (5)
- 1. No verbal response
- 2. Incomprehensible sounds.
- 3. Inappropriate words.
- 4. Confused.
- 5. Orientated.
* Best Motor Response. (6)
- 1. No motor response.
- 2. Extension posturing.
- 3. Flexion posturing.
- 4. Withdrawal from pain.
- 5. Localising pain.
- 6. Obeys Commands.
IF 8 OR LESS INTUBATE!!!!
- Get a chemstrip
- Thiamine 100mg IV
- Dextrose – 1amp D50W IV push
- Naloxone 2mg IV
- Basic bloodwork as well as tox screen
Ongoing history and physical
- HEENT: Battle sign (basal skull fracture), rhinorrhea, otorrhea, neck stiffness
- Colour (cyanosis, hypoxia, abN Hgb)
- Needle tracks
- Evidence of trauma
II – Acuity: blink to visual threat
– Pupils: size, reactivity
– Fundoscopy: papilledema and hemorrhage
III,IV,VI – Gaze deviation (conjuage – ipsilateral hemisphere, contralateral pontine)
– Doll’as eyes (oculocephalic reflex) afferent 8, efferent 3,6
– Oculovestibular (COWS, caloric reflex)
Corneal reflex afferent V1, efferent 7
Gag reflec CN 9,10
Jaw jerk CN 7
* Reflexes – DTR, Plantar, Primative (glabellar, palmomental)
* Motor exam – spontaneous movement, symmetry, purpose, tone, power, rxn to noxious stimuli
Note: RAS or bihemispheric insult is required to lose consciousness
Abdominal exam (liver disease stigmata and occult blood loss)
- Do a rectal exam
Differential Diagnosis (AEIOU TIPS)
A- alcohol, drugs, toxins
E- endocrine, exocrine(liver), electrolytes
I- insulin (diabetes)
O- oxygen, opiates
U- uremia, renal, HTN
T- trauma, temperature
I- infection (CNS, systemic)
P- psychiatric, porphyria
S- space occupying lesions, stroke, SAH, shock