Coma and GCS assessment

Meet the patient

A 58-year-old man is found unconscious at home, brought in by ambulance. His eyes stay shut, he makes no sound, the right arm withdraws to a supraorbital press while the left arm extends rigidly with adduction and internal rotation. The glucose is 6.4, the pupils 3 mm and briskly reactive, the respiratory rate 6. The story is not yet told by the history — it is told by the asymmetric motor response, and it points at a structural intracranial lesion until the CT says otherwise.[1]

The two questions that govern every coma are the two the first five minutes answer: is there a rapidly reversible cause? (the glucose, the opioid, the thiamine) and is this toxic-metabolic or structural? (the pupils decide — equal and reactive is metabolic, asymmetric or fixed is structural). Hold those two and everything below slots into place.[1]

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