An intubated patient with eye opening to pain with abnormal flexion. What is the GCS score?
(A) E2VNTM3 (B) E2VTM3 (C) E2V1M3 (D) E2VTM4
(A) Revised Glasgow Coma Scale 2014 Revised GCS (2014) Eye Opening Verbal Response Best Motor Response(M) Spontaneous 4 Oriented 5 Obeying commands 6 To speech 3 Confused 4 Localizing 5 To pressure 2 Words 3 Normal flexion(withdraw) 4 None 1 Sounds 2 Abnormal flexion 3 None 1 Extension 2 None 1 GCS specifically recommends avoiding sternal rubs as it causes bruising & responses can be difficult to interpret. They also do not recommend routine use of retromandibular pressure. Revised GCS (2014) changes are highlighted in the above table Best predictor of outcome: Motor response Repoing of non-testable score Aspects: In case of a non-testable aspect, the new GCS should be marked as NT, for "Not teste stable" For intubated patients or patients with tracheostomy, VNT is used it is no longer recommend to assign 1 point to non-testable elements, therefore a combined score should not be used.