A quick neurological assessment is an essential part of the primary survey. In general if the patient is talking appropriately he/she has clear airway, adequate ventilation and intact cerebral function. Of course this can change, hence the need for repeating the primary survey should deterioration occur. The Glasgow Coma Scale (GCS) can be used to give a reliable, repeatable and objective way of recording the conscious state of the patient. Always try to make an assessment before intubation as sedation interferes with consciousness. Record the three values separately (eg E3V3M5) as well as their sum are recorded. The lowest possible GCS (the sum) is 3 (deep coma), while the highest is 15 (fully awake person). A drop of 2 in the GCS usually requires investigation eg CT head.
