The Glasgow coma scale (GCS) in practice.

    

    The Glasgow coma scale (GCS) gives a reliable, objective way of recording the conscious state of a person. It has value in predicting ultimate outcome. 3 types of response are assessed, note in each case the best response (or best of any limb) which should be recorded.

    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.

    Causing pain is not a pleasant thing, there are acceptable and unacceptable methods. Try fingernail bed pressure with a pen/pencil, supraorbital pressure or sternal pressure (not a rub). Abnormal responses to pain can help to localize the damage:

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

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