A 34-year-old male is brought to the emergency department after a motor vehicle accident. Upon initial assessment, he opens his eyes spontaneously, follows commands when asked, and responds appropriately to questions. His Glasgow Coma Scale (GCS) score is calculated by the medical team. What is his GCS score?
A. 15
B. 20
C. 8
D. 5
E. 3
Correct Answer: A. 15
Explanation:
The Glasgow Coma Scale (GCS) is a neurological scale used to assess a patient’s level of consciousness after an injury or trauma. It is based on three parameters: eye opening, verbal response, and motor response. The total score ranges from 3 to 15, with 3 indicating deep coma or brain death, and 15 indicating full consciousness.
Breakdown of GCS Scoring:
- Eye Opening (E):
- 4: Spontaneous (opens eyes without stimulation).
- 3: To sound (opens eyes in response to verbal stimuli).
- 2: To pain (opens eyes in response to a painful stimulus).
- 1: No response.
- Verbal Response (V):
- 5: Oriented (patient responds appropriately to questions, such as name, location, and time).
- 4: Confused conversation (responds appropriately but with confusion).
- 3: Inappropriate words (responds with random words).
- 2: Incomprehensible sounds (moaning or grunting).
- 1: No response.
- Motor Response (M):
- 6: Obeys commands (follows instructions appropriately).
- 5: Localizes pain (moves to remove painful stimulus).
- 4: Withdraws from pain (pulls away from a painful stimulus).
- 3: Flexion to pain (decorticate posturing).
- 2: Extension to pain (decerebrate posturing).
- 1: No response.
In this case:
- Eye opening: Spontaneous → Score of 4.
- Verbal response: Oriented conversation → Score of 5.
- Motor response: Obeys commands → Score of 6.
Total GCS score = 4 (eye) + 5 (verbal) + 6 (motor) = 15.
This indicates a normal level of consciousness, as the patient is able to open his eyes spontaneously, engage in an oriented conversation, and obey commands appropriately.
Analysis of Incorrect Options:
B. 20:
- The GCS scale ranges only from 3 to 15. Therefore, a score of 20 is not possible.
C. 8:
- A GCS score of 8 indicates severe impairment of consciousness, with the patient likely in a coma. This score corresponds to a combination of responses that are far below what was described in this scenario.
D. 5:
- A GCS score of 5 is too low. The patient is able to open his eyes spontaneously, engage in oriented conversation, and obey commands, so the score should be higher.
E. 3:
- A GCS score of 3 represents deep unconsciousness or brain death, with no eye opening, verbal, or motor response. This is not consistent with the patient’s ability to open eyes spontaneously and respond appropriately.
Clinical Context and Importance:
The Glasgow Coma Scale is widely used in the emergency department, intensive care units, and neurology settings to assess a patient’s neurological status. The total score helps clinicians determine the severity of a patient’s brain injury or level of consciousness, guiding management decisions.
- A GCS of 15 indicates that the patient is fully conscious and aware, able to open eyes, converse normally, and follow commands.
- A GCS score of 8 or less typically suggests a patient is in a coma and may require advanced neurocritical care or imaging to assess the extent of brain injury.
Summary:
The Glasgow Coma Scale (GCS) is a vital tool in assessing the level of consciousness in trauma and neurological patients. A GCS score of 15 indicates full consciousness, where the patient can open eyes spontaneously, converse appropriately, and obey commands. Recognizing the GCS score helps in evaluating the severity of neurological impairment and guiding further management decisions in patients with head injuries or other causes of altered mental status.