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As soon as the urgent life threatening cases have been initially resuscitated, all the other patients should be urgently assessed for the extent of their injuries. A simple method of assessment of the conscious patient who does not require immediate resuscitation has been introduced by the author. It is illustrated and can be described as follows:
a. Upper limb: The patient is asked to grip two fingers of each hand of the examiner. The patient is then asked to twist in and then twist out the arms against resistance. If the patient can do this strongly, and without pain, this will only show the examiner that there are no major neurological injuries causing weakness in the upper limb. The twisting by the patient of the upper limbs against resistance will also demonstrate that there are no major bony or joint injuries. If the patient complains of any weakness or pain, the relevant area can then be examined in more detail.
b. Head and neck: The conjuctivae and ears can be inspected for any bleeding. The orbit, nose and head can be inspected and palpated for any bleeding or tenderness. The patient is then asked to clench the teeth together, and both masseters are palpated. Any weakness on one or both sides may signify a major fracture of the maxilla or mandible. The patient is then asked to turn the head to each side, but only if he or she is not complaining of any neck pain. If the patient can turn the head to each side without pain, the patient is then asked to press the head backwards on the examiner's hand. This will strain all the back muscles from the skull to the sacrum. If a tender area is complained of in the back, this should then be examined in more detail.
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