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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Glasgow Coma scale
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