The stem
A 34-year-old man is brought in after a motorcycle collision. His eyes open only when you press on his fingernail bed. He makes moaning sounds but no words. When you press above his eyebrow, his hand moves up past his chest towards your hand.
Glasgow Coma Scale
| Response | Score | Description |
|---|---|---|
| Eyes | ||
| 4 | Open spontaneously | |
| 3 | Open to sound | |
| 2 | Open to pressure | |
| 1 | No eye opening | |
| Verbal | ||
| 5 | Orientated | |
| 4 | Confused | |
| 3 | Words | |
| 2 | Sounds | |
| 1 | No verbal response | |
| Motor | ||
| 6 | Obeys commands | |
| 5 | Localising | |
| 4 | Normal flexion | |
| 3 | Abnormal flexion | |
| 2 | Extension | |
| 1 | No motor response |
Scale as in current Glasgow Coma Scale guidance.
The examiner’s questions
Question 1What is his Glasgow Coma Scale score?Show the model answer
9 out of 15: eyes 2 (open to pressure), verbal 2 (sounds), motor 5 (localising, the hand crosses the chest towards the stimulus). Write it as E2 V2 M5.
Question 2Why should you report the three components and not only the total?Show the model answer
The same total can come from very different patients. The components show what is actually impaired, and the motor response is the best predictor of outcome.
Question 3Does he need his airway secured?Show the model answer
A score of 8 or less generally means the airway is not protected and intubation is needed. At 9 he is close to that threshold: he needs an anaesthetist now, repeated assessment and readiness to intubate if he deteriorates.
Question 4What else do you assess under D, and what investigation follows?Show the model answer
Pupil size and reaction, limb movement on each side for lateralising signs, and blood glucose. A CT scan of the head and cervical spine is needed.
After you answerThe teaching pointShow
If the eyes cannot open because of swelling, or speech is impossible because of a tube, record the component as not testable and say why. Never guess a number.
The patients are written for teaching and are not real.