Neurological disability

Rapid assessment of the degree of apparent injury to the central nervous system is made by assessing the patient's response to verbal and painful stimuli and by examining the pupils. Abnormalities of the cardiorespiratory system or the presence of hypoglycaemia, alcohol or drugs can also suppress central neurological function.

Finally, the patient should be exposed such that full and complete examination can be undertaken, but at each stage the patient should be protected from hypothermia. Once this first rapid assessment of the patient's condition has been made, his condition should have begun to stabilise, although continued close observation is needed to ensure that further deterioration from a missed injury does not occur. It is only at this stage that initial radiographs (usually chest, cervical spine, pelvis) and basic monitoring (pulse oximetry, electrocardiogram (ECG), urine output) are instituted. Thereafter, a full top-to-toe reassessment of the entire patient is undertaken and specific investigations arranged as clinically indicated.

The use of a system of patient assessment such as that outlined above has many advantages. It can be undertaken promptly by a single doctor or synchronously and without interspecialty conflict when several surgeons are available. A system also makes it less likely that major areas will be omitted with the potential for missed injuries and avoidable mortality.

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