We have a quadriplegic patient in ICU who is tracheostomized as well. He is orientated he just couldnt speak because of the trachy. What is his correct GCS?
Some said that the correct was 6 because he doesnt have motor response from the upper limbs (basing from the upper extremities since they give the best motor response, even though the patient can close his eyes when you tell him to).
Then currently, the same patient delevoped subcutaneous emphysema. This condition made his eyes so puffy that he could not open them anymore, but when you tell him to, you could observe his effort in trying to open his eyes. We therefore give him a gcs of 3 for this... But others disagree and give him other gcs... Making us all confused of what his real GCS is.