You are caring for a patient who has had a recent head injury and you have been asked to carry out neurological observations every 15 minutes. You assess and find that his pupils are unequal and one is not reactive to light. You are no longer able to rouse him. What are your actions?

  • Continue with your neurological assessment, calculate your Glasgow Coma Scale (GCS) and document clearly.

  • This is a medical emergency. Basic airway, breathing and circulation should be attended to urgently and senior help should be sought.

  • Refer to the neurology team.

  • Break down the patient’s Glasgow Coma Scale as follows: best verbal response V = XX, best motor response M = XX and eye opening E = XX. Use this when you hand over.