Mr. X is admitted with traumatic brain injury in critical care unit. On assessment, he opens eyes to pain, produces incomprehensible sound and localizes upper extremities to pain. What is his score on Glasgow Coma Scale?

1. A

   E3V3M6

2. B

   E3V2M4

3. C

   E2V2M5

4. D

   E2V3M5

Appeared in: GMCH Nursing Officer-2025

Explanation

• The Glasgow Coma Scale (GCS) assesses level of consciousness through three components: Eye Opening, Verbal Response, and Motor Response.
• The patient's response 'opens eyes to pain' scores a 2 for Eye Opening (E2).
• The response 'produces incomprehensible sound' scores a 2 for Verbal Response (V2).
• The response 'localizes upper extremities to pain' scores a 5 for Motor Response (M5).
• Combining these individual scores results in the correct GCS of E2V2M5.

Why Other Options Were Wrong

• Option A: This option suggests E3 (opens eyes to speech), V3 (inappropriate words), and M6 (obeys commands), none of which match the patient's assessed responses.
• Option B: This option incorrectly assigns E3 (opens eyes to speech) and M4 (flexion withdrawal from pain). The patient opened eyes to pain (E2) and localized pain (M5).
• Option D: This option incorrectly assigns V3 (inappropriate words). The patient produced only incomprehensible sounds (V2), not recognizable words.

Related Visual

• Visual 1: Infographic: A detailed chart of the Glasgow Coma Scale (GCS) showing the scores for Eye, Verbal, and Motor responses, along with descriptions for each score level.

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.
• The GCS is a critical tool for nurses in the ICU to monitor for neurological deterioration or improvement in patients with brain injuries. A drop in the GCS score is a red flag requiring immediate physician notification.
• Accurate GCS scoring is essential for communication between healthcare providers and for making decisions about treatment, such as the need for intubation or neuro-imaging.
• What if... the patient's motor response was 'abnormal flexion (decorticate posturing)' instead of localizing pain? The motor score (M) would decrease to 3. The new GCS would be E2V2M3, with a total score of 7, indicating a severe brain injury and a significant neurological decline.

How to Approach the Question

• First, identify the three components of the Glasgow Coma Scale mentioned in the question: Eye opening, Verbal response, and Motor response.
• Read the clinical scenario carefully and extract the patient's specific response for each of the three components.
• For 'opens eyes to pain', assign the correct score from the Eye Opening scale.
• For 'produces incomprehensible sound', assign the correct score from the Verbal Response scale.
• For 'localizes upper extremities to pain', assign the correct score from the Motor Response scale.
• Combine the three scores in the E-V-M format and match it with the given options to find the correct answer.

Concept Tested & Keywords

• Concept Tested: Glasgow Coma Scale (GCS) Assessment
• Stem keywords: traumatic brain injury, critical care unit, opens eyes to pain, incomprehensible sound, localizes upper extremities to pain, Glasgow Coma Scale
• Lead-in keywords: What is his score

Question ID

Qm5z2k9BL9LpTcs59sSct1

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