Glasgow Coma Scale (GCS)

In Part A of this week's PCL, Dr Perlman ascertains that Hans "appears to be OK" - "sensible verbal responses", "appropriate motor responses" and "normal eye openings".

What Dr Perlman seems to have used here is probably the Glasgow Coma Scale (GCS) or a simplified version of the GCS to ascertain Hans' conscious state.

Overview of GCS
A neurological assessment tool that is both reliable and objective in the recording of a person's conscious state. 3 types of responses are assessed.

• Best motor response (6 grades)

1. No response to pain
2. Pain causes limb extension
3. Pain causes abnormal flexion
4. Withdraws from pain
5. Makes effort to remove painful stimulus
6. Obeys commands

• Best verbal response (5 grades)

1. None
2. Incomprehensible speech
3. Inappropriate speech
4. Confused conversation
5. Oriented

• Eye opening (4 grades)

1. None
2. In response to pain
3. In response to speech
4. Spontaneous

Scoring
Summation of highest attained scores in each of the 3 sections. The score ranges between 3 and 15.

Interpretation
3-8: Severe injury
9-12: Moderate injury
13-15: Minor injury

Who can use it?

• Doctors
• First-aiders
• Emergency Medical Services (EMS)
• Nurses

Abbreviated coma scale (AVPU)
The abbreviated coma scale (AVPU) can be used as an initial assessment in critical situations.

• Alert
• Responds to vocal stimuli
• Responds to pain
• Unresponsive

Reference
Longmore M., Wilkinson I., & Rajagopalan S. (2004) Oxford Handbook of Clinical Medicine (6th ed.) Oxford, United Kingdom: Oxford University Press