Assess airway, breathing, and circulation. Consider intubation if GCS <8. Support the circulation if required (ie IV fluids). Give O2 and treat any seizures. Protect the cervical spine.
Check blood glucose in all patients. Give 50mL 50% dextrose IV immediately if presumed hypoglycaemia.
IV thiamine if any suggestion of Wernicke's encephalopathy.
IV naloxone for opiate intoxication (may also be given IM or via ET tube); IV flumazenil for benzodiazepine intoxication if airway compromised (may precipitate seizures especially if tricyclic intoxication)
Examination
Vital signs are vital - obtain full set, including temperature.
Signs of trauma haematoma, laceration, bruising, CSF/blood in nose or ears, fracture deformity of skull, subcutaneous emphysema, "˜panda eyes"
Stigmata of other illnesses: liver disease, alcoholism, diabetes, myxoedema.
Skin for needle marks, cyanosis, pallor, rashes, poor turgor.
Smell the breath (alcohol, hepatic fetor, ketosis, uraemia).
Meningism but do not move neck unless cervical spine is cleared.
Pupils size, reactivity, gaze.
Heart/lung exam for murmurs, rubs, wheeze, consolidation, collapse.
Abdomen/rectal for organomegaly, ascites, bruising, peritonism, melaena.
Are there any foci of infection (abscesses, bites, middle ear infection?)
Any features of meningitis: neck stiffness, rash, focal neurology?
Note the absence of signs, eg no pin-point pupils in a known heroin addict.
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