A 25-year-old motorcycle rider is brought to the emergency with history of motor vehicle accident. On primary survey, he is found to open eyes in response to pain, speaking inappropriate words and localizes pain. His Glasgow Coma Scale score is
$E_2 V_3 M_5$
The correct answer is E2 V3 M5, total GCS 10. Eye opening: 4 spontaneous, 3 to voice, 2 to pain, 1 none. Verbal: 5 oriented, 4 confused conversation, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Motor: 6 obeys commands, 5 localises pain, 4 withdraws, 3 abnormal flexion (decorticate), 2 extension (decerebrate), 1 none. This patient scores 2 + 3 + 5 = 10, placing him in the moderate head injury band (9-12).
E3 V4 M4 would mean eye opening to voice, confused speech and withdrawal, none of which fits. E3 V3 M4 wrongly upgrades eye opening to voice and downgrades localising to withdrawal. E2 V4 M5 has the correct eye and motor scores but calls the speech confused conversation (V4), whereas isolated inappropriate words are V3.
Key point: Localising (M5) versus withdrawal (M4) depends on whether the hand crosses the midline towards the stimulus. GCS 13-15 mild, 9-12 moderate, 8 or less severe and needs a definitive airway.
Similar Questions
Which of the following are the important parameters to be maintained in a patient with head trauma?
1. MAP 70-80 mm Hg (mean arterial pressure)
2. Intracranial pressure < 20 mm Hg
3. Cerebral perfusion pressure > 60 mm Hg
4. Na > 140 mEq/L
Select the correct answer using the code given below.
A 25-year-old motorcycle rider is brought to the emergency with history of motor vehicle accident. On examination, the patient is tachycardic (pulse 110/min) with a BP of 90 systolic. He has an open wound in the thigh with an estimated blood loss of 1000 mL. What is the severity of haemorrhagic shock this patient is suffering from?
Important Questions from Trauma & Injury Management
- Indications for fasciotomy in compartment syndrome include all EXCEPT:
- Which one of the following statements about Compartment Syndrome is NOT correct?
Which of the following are stages of damage control surgery?
1. Patient's selection
2. Control of haemorrhage
3. Resuscitation in ICU
4. Preventive surgery
Select the correct answer using the code given below.
- A 30-year-old road traffic accident victim is being taken up for emergency laparotomy for haemoperitoneum and suspected multiorgan trauma. Which one of the following will be an indication for performing damage control surgery?
- A 30-year-old motorbike rider is brought to the emergency with history of a road traffic accident and altered consciousness. On secondary survey, the doctor notices presence of a bruise over the left mastoid process. The finding indicates
