Question 3#
A 23-year-old man presents to the ED after being a passenger in a high-speed motor vehicle accident. He was restrained and there was airbag deployment. Upon initial presentation to the ED, he was conversant, oriented, and following commands. However 20 minutes later, he is lethargic, only opening his eyes to painful stimuli, is making incomprehensible sounds, and only withdraws to pain.
What are the initial and subsequent Glasgow Coma Scores (GCS) for this patient?
A. 15, 8B. 15, 4
C. 13, 8
D. 10, 4
Correct Answer is A
Comment:
Correct Answer: A
The GCS (see figure below) is a reliable and objective way of recording the initial and subsequent level of consciousness in a person after a traumatic injury. The scale assesses patients according to three aspects of responsiveness: eye-opening, motor, and verbal responses. The levels of response in the components of the GCS are “scored” from 1, for no response, up to normal values of 4 (eye-opening response), 5 (verbal response), and 6 (motor response). The total Coma Score thus has values between 3 and 15, 3 being the worst and 15 being the highest. The findings in each component of the scale can aggregate into a total GCS, which gives a less detailed description but can provide a useful “shorthand” summary of the overall severity. Based on the question, the patient had a GCS of 15 (4+5+6) at presentation, which later decreased to 8 (2+2+4).
From Teasdale G, Jennett B. Assessment of coma and impaired consciousness. Apractical scale. Lancet. 1974;2(7872):81-84.
References:
- Merrick C. Advanced Trauma Life Support. Chicago, IL: American College of Surgeons. 2018. Print.
- Jain S, Teasdale GM, Iverson LM. Glasgow Coma Scale. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. 2019 Mar 3.