Primary Survey Disability Evaluation

Aka: Primary Survey Disability Evaluation, Emergency Disability Management, Emergency Neurologic Exam, Trauma Neurologic Exam

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II. Evaluation: Neurologic status (Primary Survey)

  1. See Rapid ABC Assessment
  2. Glasgow Coma Scale (E-V-M system 3-15 points)
  3. Level of Consciousness: (AVPU system)
    1. Alert
    2. Vocal Stimuli
    3. Painful stimuli
    4. Unresponsive
  4. Pupil response

III. Evaluation: Secondary SurveyTrauma Neurologic Evaluation (more complete)

  1. Repeat Glasgow Coma Scale
    1. Compare to Primary Survey score
    2. Serial evaluations should include at least 2 GCS scores: On ED presentation and on disposition
  2. Sensory Exam
  3. Reflex Exam
  4. Motor Exam
  5. Rectal Sphincter Tone

IV. Pitfalls: Trauma

  1. Closed Head Injury
  2. Decreased Oxygenation
  3. Shock
  4. Alcohol Intoxication
  5. Drug Intoxication

V. Imaging

  1. See CT Head

VI. Differential Diagnosis

  1. Altered Level of Consciousness
    1. See Trauma pitfalls above
    2. See Altered Level of Consciousness
    3. Delirium
    4. Cerebrovascular Accident
  2. Unconscious Trauma patient
    1. Bilateral cerebral cortex injury
    2. Brain Stem injury

VII. References

  1. (2012) ATLS Manual, American College of Surgeons

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