KEY LEARNING POINTS

• Assessment of Disability involves examination of the patient's level of consciousness, pupil size and reactivity. A brief peripheral neurological examination should be performed and blood glucose levels measured.
• Assessment of trends in the patient's level of consciousness using ACVPU or GCS are more useful than single isolated measurements.
• Blood glucose levels must be checked in any patient with a reduced level of consciousness.
• Where cerebral ischaemia or haemorrhage is suspected, look for focal neurological signs.
• A GCS < 9 places the patient at risk from an unprotected airway and an endotracheal tube is required.
• In those patients who have a low or reducing level of consciousness, request senior medical advice early.