1.
DISABILITY and EXPOSURE – identification of
neurological injuries

2.
DISABILITY and EXPOSURE – identification of
neurological injuries
ON ADMISSION

3.
DISABILITY and EXPOSURE – identification of
neurological injuries
1. GCS Scoring

4.
DISABILITY and EXPOSURE – identification of
neurological injuries
1. GCS Scoring
• Mild head injury 13-15
• Moderate head injury 9-12
• Sever head injury < 8

5.
DISABILITY and EXPOSURE – identification of
neurological injuries
1. GCS Scoring
2. Temperature

6.
DISABILITY and EXPOSURE – identification of
neurological injuries
2. Temperature
• Record the core temperature
• maintain the normal temperature using warm blankets and trolleys
• Frequent hypothermia will increase coagulopathy

7.
DISABILITY and EXPOSURE – identification of
neurological injuries
1. GCS Scoring
2. Temperature
3. Pupil

8.
DISABILITY and EXPOSURE – identification of
neurological injuries
3. Pupil
• Assessed for size
• Reaction to light

9.
DISABILITY and EXPOSURE – identification of
neurological injuries
1. GCS Scoring
2. Temperature
3. Pupil
4. Rectal Examination - normal rectal tone

10.
DISABILITY and EXPOSURE – identification of
neurological injuries
1. GCS Scoring
2. Temperature
3. Pupil
4. Rectal Examination - normal rectal tone
5. Gross Neurological Examination - Limbs movement

11.
DISABILITY and EXPOSURE – identification of
neurological injuries
1. GCS Scoring
2. Temperature
3. Pupil
4. Rectal Examination - normal rectal tone
5. Gross Neurological Examination - Limbs movement
6. Spinal injury

12.
DISABILITY and EXPOSURE – identification of
neurological injuries
6. Spinal injury
• In case of spinal injuries cervical collar
is used for cervical spine protection
• Protection of thoracolumbar spine is
done using log roll technique
Log Roll Technique : to maintain
alignment of the spine while turning
and moving the patient who has had
spinal surgery or suspected or
documented spinal injury

13.
DISABILITY and EXPOSURE – identification of
neurological injuries
6. Spinal injury
Procedure:
• Done by 4 people
• Apply a cervical collar, and place the patient’s arm by his side
• Rescuer at the lower extremities holds the patient’s lower legs and the thigh region
• Rescuer at the hip holds the patient’s lower legs and patient’s buttocks or waist
• Rescuer at the chest holds the patient’s arms and lower buttocks
• Patient is gently rolled onto the board
• Torso and extremities are strapped securely to the board
• Head is immobilized with head immobilizer
* Contra indications - Pelvic fractures may harm the patients by disturbing established blood clots

14.
DISABILITY and EXPOSURE – identification of
neurological injuries
1. GCS Scoring
2. Temperature
3. Pupil
4. Rectal Examination - normal rectal tone
5. Gross Neurological Examination - Limbs movement
6. Spinal injury
7. Whole Body CT scan (WBCT)

15.
DISABILITY and EXPOSURE – identification of
neurological injuries
7. Whole Body CT scan (WBCT)
• 1 WBCT is equal to 76 chest X-rays, hence use it wisely for severely
injured patients only

16.
DISABILITY and EXPOSURE – identification of
neurological injuries
1. GCS Scoring
2. Temperature
3. Pupil
4. Rectal Examination - normal rectal tone
5. Gross Neurological Examination - Limbs movement
6. Spinal injury
7. Whole Body CT scan (WBCT)
8. Pelvic Binder

17.
DISABILITY and EXPOSURE – identification of
neurological injuries
8. Pelvic Binder
• Any patient undergoing immediate trauma laparotomy after blunt
trauma without a WBCT scan should have a Pelvic Binder applied and
not removed until a pelvic fracture is excluded.

18.
SECONDARY SURVEY

19.
SECONDARY SURVEY
1. All severely injured patients require a detailed top to toe examination after life
threating injuries have been identified and managed during the primary survey.

20.
SECONDARY SURVEY
1. All severely injured patients require a detailed top to toe examination after life
threating injuries have been identified and managed during the primary survey.
2. Patient may be intubated and unresponsive at this time, limiting the accuracy of
clinical examination.

21.
SECONDARY SURVEY
1. All severely injured patients require a detailed top to toe examination after life
threating injuries have been identified and managed during the primary survey.
2. Patient may be intubated and unresponsive at this time, limiting the accuracy of
clinical examination.
3. Such patients should have a tertiary survey to identify any missed minor injuries such
as scaphoid fracture in wrist or rotator cuff tear in shoulder. These injuries can cause
long term disabilities.

22.
SECONDARY SURVEY
1. All severely injured patients require a detailed top to toe examination after life
threating injuries have been identified and managed during the primary survey.
2. Patient may be intubated and unresponsive at this time, limiting the accuracy of
clinical examination.
3. Such patients should have a tertiary survey to identify any missed minor injuries such
as scaphoid fracture in wrist or rotator cuff tear in shoulder. These injuries can cause
long term disabilities.
4. AMPLE history:-
• A - Allergy H/O
• M - Medical H/O
• P - Pregnancy H/O/ Present illness
• L - Last meal
• E - Explain the mechanism of injury

23.
DISABILITY and EXPOSURE – identification of
neurological injuries
ON ADMISSION
1. GCS Scoring
• Mild head injury 13-15
• Moderate head injury 9-12
• Sever head injury < 8
2. Temperature
• Record the core temperature
• maintain the normal temperature using warm blankets and trolleys
• Frequent hypothermia will increase coagulopathy
3. Pupil
• Assessed for size
• Reaction to light
4. Rectal Examination - normal rectal tone
5. Gross Neurological Examination - Limbs movement

24.
6. Spinal injury
• In case of spinal injuries cervical collar is used for cervical spine protection
• Protection of thoracolumbar spine is done using log roll technique
Log Roll Technique : to maintain alignment of the spine while turning and moving the patient who has had spinal surgery or suspected
or documented spinal injury
Procedure:
• Done by 4 people
• Apply a cervical collar, and place the patient’s arm by his side
• Rescuer at the lower extremities holds the patient’s lower legs and the thigh region
• Rescuer at the hip holds the patient’s lower legs and patient’s buttocks or waist
• Rescuer at the chest holds the patient’s arms and lower buttocks
• Patient is gently rolled onto the board
• Torso and extremities are strapped securely to the board
• Head is immobilized with head immobilizer
* Contra indications - Pelvic fractures may harm the patients by disturbing established blood clots
7. Whole Body CT scan (WBCT)
• 1 WBCT is equal to 76 chest X-rays, hence use it wisely for severely injured patients only
8. Pelvic Binder
• Any patient undergoing immediate trauma laparotomy after blunt trauma without a WBCT scan should have a Pelvic Binder
applied and not removed until a pelvic fracture is excluded.

25.
SECONDARY SURVEY
1. All severely injured patients require a detailed top to toe examination after life
threating injuries have been identified and managed during the primary survey.
2. Patient may be intubated and unresponsive at this time, limiting the accuracy of
clinical examination.
3. Such patients should have a tertiary survey to identify any missed minor injuries such
as scaphoid fracture in wrist or rotator cuff tear in shoulder. These injuries can cause
long term disabilities.
4. AMPLE history:-
• A - Allergy H/O
• M - Medical H/O
• P - Pregnancy H/O/ Present illness
• L - Last meal
• E - Explain the mechanism of injury