for the patient that you scored 10(the one who was conscious and coherent), you are right when you scored him 5
for the best verbal response
as the patient was orientated and 4
for the best eye response
as the patient eyes were spontaneously open then you scored him 1 for the best motor response.
remember, with the best motor response
, you are not scoring your patient by only considering limb power alone, instead you are scoring them for the following aspects:
. no response to pain.
2.extensor posturing to pain:
the stimulus causes limb extension (adduction, internal rotation of shoulder, pronation of forearm) - decerebrate posture
3.abnormal flexor response to pain:
pressure on the nail bed causes abnormal flexion of limbs - decorticate posture
4.withdraws to pain:
pulls limb away from painful stimulus.
5.localizing response to pain:
put pressure on the patient's finger nail bed with a pencil then try supraorbital and sternal pressure: purposeful movements towards changing painful stimuli is a 'localizing' response.
the patient does simple things you ask (beware of accepting a grasp reflex in this category).
if i will assess your patient who was conscious and coherent, i will probably ask him to do simple things such as: "give me a smile", "open your mouth", or "stick your tongue out". if he obey these commands then he will have a score of 6
for the best motor response
therefore his gcs
will be 15/15.
i hope these pointers will give you a bit of guidance about gcs and neurological assessment. best of luck!!!