Following a road accident, a patient was admitted to the neurosurgery ICU due to a head injury. During the assessment, the patient opens his eyes to painful stimuli but not to verbal stimuli. He answers questions by making incomprehensible sounds and localises the site of the painful stimulus. His GCS score will be:

1. A

   9

2. B

   8

3. C

   6

4. D

   7

Appeared in: AIIMS Jodhpur SNO-2023

Explanation

• The Glasgow Coma Scale (GCS) is calculated by summing the scores for Eye opening (E), Verbal response (V), and Motor response (M).
• The patient's eye opening to painful stimuli scores 2 points (E2).
• Making incomprehensible sounds for verbal response scores 2 points (V2).
• Localising the site of a painful stimulus for motor response scores 5 points (M5).
• The total GCS score is the sum of these individual scores: E2 + V2 + M5 = 9.

Why Other Options Were Wrong

• Option B: A score of 8 is incorrect. This would typically indicate a more severe injury or a different combination of responses, such as withdrawal from pain (M4) instead of localising (M5), resulting in a score of E2+V2+M4=8.
• Option C: A score of 6 is incorrect. This would represent a significantly lower level of function, for example, abnormal flexion (decorticate posturing) as a motor response (M3), resulting in E2+V2+M2=6 (assuming extension response). The patient clearly localises pain (M5).
• Option D: A score of 7 is incorrect. This score does not match the sum of the patient's specific responses. A score of 7 could be E2+V2+M3 (abnormal flexion).

Related Visual

• Visual 1: Chart - A standard Glasgow Coma Scale chart detailing the scoring for eye, verbal, and motor responses. This helps in quickly referencing the points for each level of response.
• Visual 2: Infographic - An infographic illustrating the difference between localising pain, withdrawal, and abnormal flexion/extension, which are key differentiators in the motor score.

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Glasgow Coma Scale (GCS) Assessment in acute care settings.
• A GCS score of 9 is classified as a moderate head injury (GCS 9-12). Scores of 8 or less indicate a severe head injury, often requiring intubation for airway protection.
• Nurses in critical care settings perform frequent GCS assessments to monitor for neurological deterioration. A drop in the GCS score, even by one point, is a critical finding that must be reported to the physician immediately.
• What if? If the patient's motor response had been 'withdrawal from pain' (M4) instead of 'localising' (M5), the GCS score would have been 8 (E2+V2+M4). This would classify the injury as severe and likely prompt immediate intervention, such as intubation, to protect the airway.

How to Approach the Question

• First, identify that the question requires calculating a Glasgow Coma Scale (GCS) score based on a clinical scenario.
• Recall the three components of the GCS: Eye Opening (E), Verbal Response (V), and Motor Response (M).
• Systematically evaluate the patient's description for each component and assign the corresponding score.
• For Eye Opening: 'opens his eyes to painful stimuli' = 2 points.
• For Verbal Response: 'making incomprehensible sounds' = 2 points.
• For Motor Response: 'localises the site of the painful stimulus' = 5 points.

Concept Tested & Keywords

• Concept Tested: Glasgow Coma Scale (GCS) Assessment
• Stem keywords: head injury, neurosurgery ICU, GCS score, opens eyes to painful stimuli, incomprehensible sounds, localises site of painful stimulus
• Lead-in keywords: GCS score will be
• Clinical cues: Patient with head injury in ICU setting, requiring neurological assessment.

Question ID

Q9rSSqg1284Fyjj0Z5M_k7

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