GCS

Question 1

what are the 3 categories

Answer 1

Best motor response, Best verbal response, Eye opening

Question 2

motor response

Answer 2

6 - obeying commands
5 -- localizing to pain
4 - withdrawing to pain
3 - flexor response to pain
2 - extensor response to pain
1 - no response to pain

Question 3

verbal response

Answer 3

5 - oriented in time, place nad person
4 - confused conversation
3 - inappropriate speech
2 - incomprehensible sounds
1 - none

Question 4

eye opening

Answer 4

4 - spontaneous
3 - in response to speech
2 - in response to pain
1 - none

Question 5

overall score classifications

Answer 5

An overall score is made by summing the score in the 3 areas assessed.

• No response to pain + no verbalization + no eye opening = 3
• Severe injury, GCS ≤8—consider airway protection
• Moderate injury, GCS 9–12
• Minor injury, GCS 13–15.

Question 6

acceptable methods of causing pain

Answer 6

Try fi ngernail bed pressure with a pen/pencil, supraorbital pressure or sternal
pressure (not a rub)

Question 7

Abnormal responses to pain can help to localize the damage:

Answer 7

• Flexion = decorticate posture (arms bent inwards on chest, thumbs tucked in a
clenched fi st, legs extended) implies damage above the level of the red nucleus in
the midbrain.1
• Extension = decerebrate posture (adduction and internal rotation of shoulder, pronation
of forearm) indicates midbrain damage below the level of the red nucleus.

Question 8

an abbreviated coma scale

Answer 8

an abbreviated coma scale, AVPU, is sometimes used in the initial assessment
(‘primary survey’) of the critically ill:
A = alert
V = responds to vocal stimuli
P = responds to pain
U = unresponsive