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Initial assessment of the injured child

so what's happened? he came off onto his head. He came off the scooter. And my son came in to tell me. He's been out for 5 minutes. But he’s… can we just lie you back down? That's it sweetheart. Well done he's been sick a couple of times. And he's been out unconscious, the last 4 minutes did you see this happen at all? I was inside while my other son came inside and said " daddy, daddy, toby's come off his scooter and he wasn't moving for 5 minutes  And does he have any medical problems at all? 
no, no it's just this are there any allergies I need to know about? no, no, no. It's just this. What do we do? it's okay, let's just have a good look at him first and then we'll go from there hello young man, how are you? Can we have a quick look at your mouth?  yes well done it's nice and clear And what's your name? Toby  Toby. How old are you, Toby? 5 and a half you're 5 and a half.  Excellent. Can you pop your arm down here for me? Is that ok? Are you hurting anywhere?
um yes does your head hurt? yes oh dear, let's have a quick look at your chest here ok? is he going to be alright? give me 5 minutes. Let's have a quick look at him first ok? Don't worry at the moment. Good that's fine. Have you any pain in your tummy? Can I have a quick feel of your tummy?
um yes
ok. That feels good. Any pain here? no  shouldn't we get him to a hospital or something? What's going on? so we are going to have a quick assessment of him first and a good look. Ok? So his airway’s good? yes. Airway’s clear. Breathing fine so he's pulse is good, nice, really good circulation. Ok, so we've got him mobilised, so we think about getting the scoop yes And we block him as well when we get him on the truck and then we do a complete secondary survey yes we're going to have a quick check at the back of his head for head wounds. Ok?
It's alright, Toby. Don’t worry. It's ok no blood there keep nice and still you're doing really well. Good boy.No blood there. No blood there too. Just have a quick look in his ears to. That's fine, no blood there Can we have a look up your nose? Good and then let's have a look at your eyes? Wow, can you open this eye for me? that's it, well done well done, you're doing really well. Well done. Can I have a quick look at your mouth again? Good well done, close that mouth. Well done. Excellent. Good. Can you take a deep breath? Toby inhales And relax.
Breathe out for me Toby exhales good and again. And breathe out. Does your chest hurt at all? no No. Good. We're in a position now, where we can get the equipment and be ready to immobilise him. So I'll go and get them for you. Ok can I do anything? you stay here with him and reassuring him at the moment. Everything's ok. Alright? Ok, Toby Toby, Toby you'll be alright, ok indignantlyI know!

In this clip we see the paramedics doing an initial assessment of the injured child, Toby. An important part of this assessment in head injuries is the Glasgow Coma Scale.

Conscious level in children and adults can be assessed using the Glasgow Coma Scale; this is a scale which divides responsiveness into 3 separate domains: eyes, voice and motor functioning. These are each given a score and the maximum possible total is 15. Eyes score between 1 and 4. Voice scores between 1 and 5, and motor functions score between 1 and 6. The lowest possible score is 3 which would mean no response to any kind of stimulus in either eyes, voice or motor functions. A GCS of 15 suggests that somebody is alert with their eyes open, talking to you and moving normally.

Glasgow Coma Scale

Best Eye Opening

Adult Score Paediatric
Spontaneously 4 Spontaneously
To verbal stimuli 3 To verbal stimuli
To painful stimuli 2 To painful stimuli
No eye opening 1 No eye opening

Best Verbal Response

Adult Score Paediatric
Oriented 5 Smiles, oriented to sounds, follows objects, interacts
Confused 4 Cries but consolable, inappropriate interactions
Inappropriate words 3 Inconsistently inconsolable, moaning
Incomprehensible 2 Inconsolable, agitated
No verbal response 1 No verbal response

Best Motor Response

Adult Score Paediatric
Obeys commands 6 Normal spontaneous
Localised pain 5 Withdraws to touch
Withdraws to pain 4 Withdraws to pain
Flexible to pain 3 Flexion to pain
Extension to pain 2 Extension to pain
No motor response 1 No motor response

Using the GCS scoring method, calculate Glasgow Coma Scale for Toby based on what you’ve seen so far. Use the comments below to discuss your answer.

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Emergency and Urgent Care for Children: a Survival Guide

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