First Things First (assess & treat for the following):

• Ensure airway and breath sounds.
• Ensure IV access and perfusion.
• What is the current neuro status?
  • Determine Glasgow Coma Score (GCS); see “History and Physical” section
  • Serial neuro exams
  • Action for deteriorating exam
  • Lateralizing findings (ie, hemiparesis; suggest surgical lesion)
• Hypoxic or hypotensive?
  • Correct ASAP to prevent further ischemia.
  • Intubation if GCS 8 or less
  • Maintain O2 sat >90%.
  • Maintain SBP >90 mmHg (increased mortality for each hypotensive or hypoxic episode).
• C-spine protected?
  • Frequent co-injury w/ traumatic brain injury (TBI)
  • Other injuries are difficult to identify & treat in TBI pts.