IN the US the doctors and nurses are pretty much on the same page about this. It is not that the patient cannot physically open their eyes.....but that if they weren't swollen could/would they......you need to follow what your facilities procedure for the standard of practice. In teh nUS I would asterisk (star) the entry with an explanation as to my findings
The Glasgow coma scale (GCS) is a reliable and universally comparable way of recording the conscious state of a person. Three types of response are measured, and added together to give an overall score. The lower the score the lower the patient's conscious state. The GCS is used to help predict the progression of a person's condition.
The three responses measured are:
- Best motor response - maximum score of 6
- Best verbal response - maximum score of 5
- Eye opening - maximum score of 4
The lowest score for each category is 1, therefore the lowest score is 3 (no response to pain + no verbalization + no eye opening). A GCS of 8 or less indicates severe injury, one of 9-12 moderate injury, and a GCS score of 13-15 is obtained when the injury is minor.
Grades of Best Motor Response
6 Carrying out request ('obeying command') -patient does simple things you ask.
5 Localizing response to pain.
4 Withdrawal to pain - pulls limb away from painful stimulus.
3 Flexor response to pain - pressure on nail bed causes abnormal flexion of limbs - decorticate posture.
2 Extensor posturing to pain - stimulus causes limb extension - decerebrate posture.
1 No response to pain.
Grades of Best Verbal Response
5 Oriented - patient knows who and where they are, and why, and the year, season and month.
4 Confused conversation - patient responds in conversational manner, with some disorientation and confusion.
3 Inappropriate speech - random or exclamatory speech, with no conversational exchange.
2 Incomprehensible speech - no words uttered, only moaning.
1 No verbal response.
4 Spontaneous eye opening.
3 Eye opening in response to speech - that is, any speech or shout.
2 Eye opening in response to pain.
1 No eye opening.