Obviously, direct pressure must not be applied to any regions of skull depression or brain tissue. Hemostats must not be applied to cerebral tissue. A patient with a severe injury or developing neurologic deficit must be rapidly evaluated for treatment and transfer. While the amount of information presented in ATLS may appear overwhelming, the basic principle of first assessing the ABCs should be thoroughly understood and practiced by anyone dealing with a trauma patient. Do not give into the temptation of palpating a scalp wound or looking at the pupils until the patient has a secure airway, is breathing adequately, and has a stabilized circulatory status.
Nothing is more important than the ABCs.
See the below table. The numbers are not as important as understanding the basic principles and being able to describe to someone what the patient can or cannot do at a given moment. Neurologic improvement or deterioration must be assessed early and frequently. Using the GCS, evaluate the patient according to the degree of stimulation required to produce a given response. Responses to stimuli allow the physician to determine the patient's basic mental status.