Following the primary survey, the secondary survey allows for a more detailed history, as well as a head-to-toe exam. The history is patterned on the SAMPLE mnemonic. Stabilization of the cervical spine should continue until cleared by Radiology or Neurosurgery. Head trauma does not cause hypotension, except in very young infants or patients with severe scalp lacerations. Hypertension and bradycardia associated with slow or irregular breathing (Cushing's triad) are indications of increased intracranial pressure (ICP). If present, treatment as detailed in the section on severe TBI should be started immediately (in the ER). Very young children may not show the full triad; in particular, hypertension may not occur or may only develop shortly before brain herniation. Neurologic exam should include: mental status (reassessment of GCS) pupillary responses, esp. asymmetry cranial nerves, EOMs motor responses fundoscopy (retinal hemorrhages with "shaken baby syndrome") palpation of scalp looking for any "step-off" indicative of depressed skull fracture "Clinical" Pages: Previous 1 2 3 4 Next