judging GCS

Question 1

Eye opening

Answer 1

Eye opening
Spontaneous 4
To speech 3
43
To pain 2
None 1

Question 2

Best verbal response*

Answer 2

Best verbal response*
Oriented 5
Confused conversation 4
Inappropriate speech 3
Incomprehensible 2
None 1

*Notes on best verbal response:
Oriented = patient knows who he is, who you are and where he is, month, year and season.

Confused = patient responds in conversational manner but some disorientation and confusion

Inappropriate speech = random speech, swearing etc.

Question 3

Best motor response

Answer 3

Best motor response
To verbal command 6
Localises to pain 5
Withdrawal flexion to pain 4
Abnormal flexion to pain 3
(decorticate rigidity)
Extension to pain 2
(Decerebrate rigidity)
None 1

Question 4

Interpretation of results:

Answer 4

Interpretation of results:
GCS 8 or less - severe injury
GCS 9-12 - moderate injury
GCS 13-15 - minor injury
50% of patients with a GCS score

Question 5

Under what circumstances might you not be able to assess GCS accurately?

Answer 5

Under what circumstances might you not be able to assess GCS accurately?
Examples include when the patient’s eye is closed by swelling, when an endotracheal tube or
tracheotomy is present, stroke patients who are aphasic, and when the patient has no use of one limb
– for best motor response you should usually record the best arm response.

Question 6

How would you test pain?

Answer 6

You could use either a sternal rub, pressing on the nail bed or pressing on the supraocular area.