**2. Clinical examination**

The clinical examination of a patient with suspected haemorrhagic shock and TBI is aimed at determining the source of the bleeding from any systemic external or internal injuries and understanding the severity of the head injury. The cursory examination of the neurological status involves the evaluation of the Glasgow Coma Scale (GCS) and pupils, which will help assess the need for further radiological evaluation or urgent surgical intervention. One should be mindful that haemorrhagic shock is one of the confounding factors in the assessment of GCS. The detailed examination of the patient must include an assessment of the airway, breathing, circulation, and disability. While the patient is being stabilized, the neurological examination and examination to rule out other injuries like haemothorax, hemoperitoneum, or long bone fractures will continue, and appropriate measures can be taken to control the ongoing haemorrhage, if any. It is important to remember that the scalp can be a significant source of bleeding in children and should be scrutinized. In a patient with TBI and shock, bilaterally dilated and fixed pupils (in the absence of local injury and any drug overdose) can be an ominous sign that signifies a poorer outcome [12].
