Spontaneously Spontaneously 4 Eye To Verbal stimuli To Verbal stimuli 3 Opening To Central Pain stimuli To Central Pain stimuli 2 [E] No Response No Response 1 Unable to open eye [swelling,ptosis] Unable to open eye [swelling,ptosis] C Verbal Orientated [person/place] Alert/babbles/coos words to usual ability 5 Response Confused usual ability/spontaneous irritable cry 4 [V] Inappropriate words Cries inappropriately 3 Inappropriate sounds Occaisonally whimpers/moans 2 None None 1 Intubated or Trache T Adult/Child Child/Infant Obeys Commands Spontaneous normal movements 6 Motor Localises to painful stimuli Withdraws to touch 5 Response Withdraws to pain Withdraws to pain 4 [M] Abnormal flexion to pain Abnormal flexion 3 [decorticate rigidity] [decorticate rigidity] Abnormal Extension to pain Abnormal extension 2 [decerebrate rigidity] [decerebrate rigidity] No response No response 1 Paralysed [Spinal Injury or Muscle relaxed] P Total Paediatric GCS /15
**Modified GCS for Non Verbal Patients [Consider normal abilites]
Spontaneous normal facial/oro-motor activity 5 Less than usual spontaneous ability or response to touch 4 *Grimace Vigorous grimace to pain 3 [G] Mild grimace to pain 2 No Response to pain 1 Application of pain as a stimulus should be central - supra-orbital pressure [press hard with thumb beneath medial end of the eyebrow] or a Trapezius squeeze.
DO NOT use sternal rub [this does not elicit a true reflection of central nervous activity & can cause significant bruising].
If supra-orbital pressure is contraindicated [due to facial swelling or fracture] pinch the ear lobe or as a last option the fingernail bed can be used. Score as usual in the presence or possibility of sedative drugs but note what they have had.
