A 54-year-old man is brought to the emergency department 10 minutes after being involved in a motor vehicle accident. He was an unrestrained driver and hit a car while speeding on the highway. On arrival to the emergency department, he is spontaneously breathing and noncyanotic. His temperature is 37°C (98.6°F), blood pressure is 104/50 mm Hg, pulse is 122/min, and respirations are 16/min. Examination shows facial lacerations and multiple ecchymoses on the anterior chest and abdomen. He appears obtunded. Which of the following is a component of the Glasgow coma scale (GCS) assessment for this patient?

Question

A 54-year-old man is brought to the emergency department 10 minutes after being involved in a motor vehicle accident.  He was an unrestrained driver and hit a car while speeding on the highway.  On arrival to the emergency department, he is spontaneously breathing and noncyanotic.  His temperature is 37°C (98.6°F), blood pressure is 104/50 mm Hg, pulse is 122/min, and respirations are 16/min.  Examination shows facial lacerations and multiple ecchymoses on the anterior chest and abdomen.  He appears obtunded.  Which of the following is a component of the Glasgow coma scale (GCS) assessment for this patient?

Quizplus · Accepted Answer

This patient presents after a trauma with obtunded mental status and multiple ecchymoses on the chest and abdomen. All trauma patients should be first assessed using the GCS, which estimates the severity of the patient's neurologic injury for triage. The GCS can also give some prognostic information when used in conjunction with the patient's age and presence of concomitant adverse clinical findings, such as hypoxia, cardiovascular compromise, increased intracranial pressure, and radiographic evidence of a midline shift of the brain. Calculation of GCS score is shown below. 11ec25c8_d1ad_d56c_bc81_f35f1f25a829_MD0003_00 The GCS is used to predict the prognosis of coma and other medical conditions, such as bacterial meningitis, traumatic brain injury, and subarachnoid hemorrhage. However, the GCS is not used to diagnose coma in a patient. Findings used to diagnose coma include impaired brainstem activity (e.g., disruption of the pupillary light, extraocular, and corneal reflexes), motor dysfunction (e.g., decorticate or decerebrate posturing), and impaired level of consciousness (Choice E). (Choice A) Capillary refill is a marker of peripheral perfusion. It can be delayed beyond the normal 3 seconds in hypotension and volume depletion but is not used in the GCS. (Choice B) Exaggerated deep tendon reflexes can be seen in locked-in syndrome, which mimics coma but is due to an ischemic or hemorrhagic stroke of the brainstem area. Patients have total paralysis of the limbs and an inability to speak, retain cognition and alertness, and can only communicate with their eyes. (Choice D) The gag reflex is tested to evaluate for proper cranial nerve function and swallowing mechanism to prevent foreign objects from entering the pharynx, larynx, or trachea. Up to 20% of the normal patients can have an absent gag reflex. This is not used as a test in the GCS. Educational objective: All trauma patients should be triaged using the Glasgow coma scale (GCS), which can predict the severity and prognosis of coma, during the primary survey. The GCS assesses the patient's ability to open his/her eyes, motor response, and verbal response.

A 54-Year-Old Man Is Brought to the Emergency Department 10