A 19-year-old woman collapses at a concert and is witnessed to have a tonic-clonic seizure lasting 2 minutes. When the paramedics arrive and ask her questions, she mumbles but no-one can understand what she is saying. Only when the paramedic applies pressure to her nailbed does she open her eyes and reach out with her other hand to rub her nail and then push him away. What is her Glasgow Coma Scale (GCS)?
Ans: Glasgow Coma Scale
(D) The GCS is frequently used to assess level of consciousness. The lowest score is 3, the highest 15. A score of 8 or below is classified as coma. GCS is assessed by evaluating eye (1–4), verbal (1–5) and motor (1–6) response. Clinically, it is best to assess for the highest possible score and work down. So, if a patient is not opening their eyes spontaneously, assess whether they respond to verbal command and only then to pain. In this case, E = 2 (responds to pain), V = 2 (incomprehensible sounds), M = 5 (localizes to pain), giving this patient a GCS of 9/15. It is important to carefully monitor her GCS, like most measurements a trend is more useful than a one-off assessment.