D
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 AVPU 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 < 8 places the patient at risk from an unprotected airway and an endotracheal tube is required. Call for anaesthetic help.
- In those patients who have a low or reducing level of consciousness, request senior medical advice early.
- It is important to keep reassessing ABCDE and treat appropriately. Consciousness can deteriorate as a result of ABC not being adequately dealt with and vice versa.
