GCS

Question 1

What is the GCS used for?

Answer 1

To evaluate a patients level of consciousness

Question 2

What are the 3 components that are assess for in the GCS?

Answer 2

Eye opening

Motor response

Speech performance

Question 3

What is the highest score possible on GCS (indicates normal cosncious level)?

Answer 3

15

Question 4

What is the lowest GCS score someone can have?

Answer 4

3

Question 5

What is the maximum score from the eye-opening response and what does this equate to?

Answer 5

4 - spontaneous eye opening

Question 6

What scores 3 for eye-opening?

Answer 6

Eyes open to speech

Question 7

What scores 2 for eye-opening?

Answer 7

Eyes open in response to painful stimulus

Question 8

What scores a 1 for eye-opening?

Answer 8

Eyes fail to open in response to a painful stimulus

Question 9

If the patient cannot open their eyes for some reason (oedema, trauma etc.), what should be recorded?

Answer 9

‘Not testable’

Question 10

What is the maximum possible score a patient can get in the verbal response section of GCS?

Answer 10

5

Question 11

What scores 5 points in the verbal response section?

Answer 11

An orientated response - i.e. the patient correctly answers questions such as ‘can you tell me where you are?’, ‘can you tell me your name?’, ‘can you tell me the date today?’

Question 12

What scores 4 points in the verbal response section?

Answer 12

Confused response - they answer your questions but incorrectly

Question 13

What scores 3 points in the verbal response section?

Answer 13

Inappropriate words - random words that are completely unrelated to the questions you asked

Question 14

What scores 2 points in the verbal response section?

Answer 14

Incomprehensible sounds - e.g. making groans

Question 15

What scores 1 point in the verbal response section?

Answer 15

No response

Question 16

If the patient is intubated or has a tracheostomy and cannot speak, how would you record their voice response?

Answer 16

‘Not testable’

Question 17

What is the maximum possible score in the motor movements section of GCS?

Answer 17

6

Question 18

In order to score 6 points, does the patient need to be able to move both limbs equally?

Answer 18

No

Question 19

What scores 6 points for the motor response section of GCS?

Answer 19

Obeys commands - i.e. ‘lift your right arms off the bed and make a fist’

Question 20

What scores 5 points for the motor response section of GCS?

Answer 20

Localises to pain - apply a painful stimulus (trapezius squeeze or pressure on supraorbital notch) and the patient moves a limb towards the site of painful stimulus

Question 21

What scores 4 points for the motor response section of GCS?

Answer 21

Withdraws from pain - the patient performs a ‘normal flexion response’ in response to a painful stimulus, i.e. patient flexes their arm when a painful stimulus is applied to their fingertip

Question 22

What scores 3 points for the motor response section of GCS?

Answer 22

Abnormal flexion response to pain - results in decorticate posturing whereby the arms adduct and internal rotation at the shoulders

This response indicates significant damage to the cerebral hemispheres and internal capsule and thalamus

Question 23

What scores 2 points for the motor response section of GCS?

Answer 23

Abnormal extension response to pain - results in decerebrate posturing where the head, arms and legs are all extended and internally rotated, patient is rigid with their teeth clenched. This posturing may be only on one side of the body and may only be present in the arms

This type of posturing indicates damage to the brainstem and can indicate lesions in the midbrain or cerebellum

Question 24

What does progression from decorticate to the decerebrate posturing indicate?

Answer 24

Tonsillar brain herniation

Question 25

What scores 1 point for the motor response section of GCS?

Answer 25

No response to painful stimulus

Question 26

If the patients motor response cannot be tested (e.g. paralysis), how is this recorded?

Answer 26

‘Not testable’

Question 27

How should the GCS score be recorded?

Answer 27

Write down the total GCS score and then record their score for each individual component

e.g. GCS 14 (E3, V5, M6)