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Visual Diagnosis # 13


A 45 yr-old male arrives via ambulance in the emergency department found lying on the sidewalk unresponsive but with stable vital signs and no acute signs of trauma. The patient is very well known to EMS and emergency department staff and has a history of chronic alcohol abuse. Upon arrival in the emergency department his vital signs are stable and finger stick blood sugar is within normal limits.

Your primary survey reveals an unconscious male with a normal respiratory rate and tidal volume. He has no acute signs of trauma and is moving all his extremities. The patient is able to open his eyes in response to voice, he is confused and disoriented and localizes painful stimuli.

1. What is his GCS (Glasgow Coma Scale) ?

During your secondary survey you examine his tympanic membranes.



2. What is this finding called?

3. What does this finding indicate?


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