Rapidly assess the child’s mental state using the AVPU scale. Use firm supraorbital pressure as the painful stimulus.
* A Alert
* V Responds to voice
* P Responds to pain
----> Purposefully
----> Non-purposefully :
- Withdrawal/flexor response
- Extensor response
Assess pupil size, equality and reactivity and look for other focal neurological signs.
Perform a secondary survey looking specifically at:
* Neck and cervical spine – deformity, tenderness, muscle spasm
* Head – scalp bruising, lacerations, swelling, tenderness, bruising behind the ear (Battles sign)
* Eyes – pupil size, equality and reactivity, fundoscopy
* Ears – blood behind the ear drum, CSF leak
* Nose – deformity, swelling, bleeding, CSF leak
* Mouth –dental trauma, soft tissue injuries
* Facial fractures
* Motor function – examine limbs for presence of reflexes and any lateralising weakness
* Perform a formal Glasgow Coma Score
* Consider the possibility of non-accidental injury during secondary survey especially in infants with head injury.
* Other injuries