"improving intensive care in Scotland"

Assessment and treatment of the acutely ill adult

D for Disability

In the ABCDE system this is usually labelled 'disability'. This is a bit naff as it really means 'central nervous system function'. Assess the GCS or AVPU score, check the pupils for symmetry, size and reactivity and quickly assess limb function.

AVPU Score




Responds to verbal stimulus


Responds to painful stimulus



A letter is assigned based on the patient's best response. E.g. AVPU score of V means the patient responds to verbal stimulus such as calling his name.

DEFG: in any confused patient or patient with reduced conscious level Don't Ever Forget Glucose. Hypoglycaemia is a common cause of reduced level of consciousness (usually insulin or drug induced) . Hypoglycemia can be caused by severe sepsis; this is a poor prognositic indicator.

If the patient is hypoglycaemic but hasn't taken exogenous insulin or oral hypoglycaemic agents consider:

liver failure (check prothrombin ratio, another dynamic monitor of hepatic synthetic function) hypoadrenalism (Addison's disease). Also see page 215 of the Lothian Adult Medical Emergencies Handbook

Insulinoma is very rare.


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