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Glasgow Coma scale

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GCS is a very useful score. Changes may be more important than actual values. I always encourage doctors to say what patients can do rather than discuss just numbers. It gives us a useful framework to discuss comatose patients. Be sensible, a dysphasic patient perhaps due to a stroke affecting speech areas may have no speech but should not really be graded as a 1 without explicitly saying he/she is dysphasic.

Patients at GCS of 8 and below tend to be intubated to protect the airway and prevent hypoxia and aspiration pneumonitis. If GCS is reduced always seek senior support. See Coma

Eye opening (E4) There are 4 grades
4	Eyes open spontaneously.
3	Eye open to sound. (wake patient if asleep)
2	Eye opening to pressure. (supraorbital and sternal pressure/rub.)
1	None.
Verbal response (V5) There are 5 grades:
5	Oriented. (Patient responds coherently and appropriately to questions such as the patient's name and age, where they are and why, the year, month, etc.)
4	Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
3	Words. (Random or exclamatory articulated speech, but no conversational exchange).
2	Sounds. (Moaning but no words.)
1	None.
Best motor response (M6)There are 6 grades
6	Obey commands. (The patient follows simple commands)
5	Localises to pain. (Purposeful movements towards changing painful stimuli; e.g. hand crosses mid-line and gets above clavicle when supra-orbital pressure applied.)
4	Withdraws from pain (pulls part of body away when pinched; normal flexion).
3	Flexion to pain (decorticate response).
2	Extension to pain (decerebrate response, adduction, internal rotation of shoulder, pronation of forearm).
1	No motor response.

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PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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