Cerebral circulation may be impaired resulting in altered level of consciousness. In a multiply injured patient blood loss is the commonest cause of diminished conscious level. External, severe haemorrhage should be identified and controlled by direct manual pressure on the wound. Pulse, blood pressure, and respiratory rate can give you some idea of the amount of blood loss. 35 Note that you may see a drop in blood pressure only after significant blood loss.
Young patients maintain their blood pressure better than old people.
A rapid assessment of the neurological state can be made by seeing if the patient is speaking to you, by looking at the pupils and assessing the level of consciousness. The GCS was described in detail in last month's article on head injury. Your patient should be resuscitated while the primary survey is being conducted. The aim of resuscitation is to achieve good tissue perfusion. This includes establishing that the airway, ventilation, oxygenation, and circulation are all adequate.