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Editor's Notes

• #23: Alert - a fully awake (although not necessarily orientated) patient. This patient will have spontaneously open eyes, will respond to voice (although may be confused) and will have bodily motor function. Voice - the patient makes some kind of response when you talk to them, which could be in any of the three component measures of Eyes, Voice or Motor - e.g. patient's eyes open on being asked "are you okay?!". The response could be as little as a grunt, moan, or slight move of a limb when prompted by the voice of the rescuer. the patient makes a response on any of the three component measures when pain stimulus is used on them. Recognized methods for causing the pain stimulus include a Sternal rub (although in some areas, it is no longer deemed acceptable), where the rescuers knuckles are firmly rubbed on the breastbone of the patient, pinching the patient's ear and pressing a pen (or similar instrument) in to the bed of the patient's fingernail. A fully conscious patient would normally locate the pain and push it away, however a patient who is not alert and who has not responded to voice (hence having the test performed on them) is likely to exhibit only withdrawal from pain, or even involuntary flexion or extension of the limbs from the pain stimulus. The person assessing should always exercise care when performing pain stimulus as a method of assessing levels of consciousness, as in some jurisdictions, it can be considered assault. This is a key reason why voice checks should always be performed first, and the person assessing should be suitably trained. Sometimes seen noted as 'Unconscious', this outcome is recorded if the patient does not give any Eye, Voice or Motor response to voice or pain.
• #24: Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form "GCS 9 = E2 V4 M3 at 07:35". Generally, brain injury is classified as: Severe, with GCS ≤ 8 Moderate, GCS 9 - 12 Minor, GCS ≥ 13.
• #25: Alert - a fully awake (although not necessarily orientated) patient. This patient will have spontaneously open eyes, will respond to voice (although may be confused) and will have bodily motor function. Voice - the patient makes some kind of response when you talk to them, which could be in any of the three component measures of Eyes, Voice or Motor - e.g. patient's eyes open on being asked "are you okay?!". The response could be as little as a grunt, moan, or slight move of a limb when prompted by the voice of the rescuer. the patient makes a response on any of the three component measures when pain stimulus is used on them. Recognized methods for causing the pain stimulus include a Sternal rub (although in some areas, it is no longer deemed acceptable), where the rescuers knuckles are firmly rubbed on the breastbone of the patient, pinching the patient's ear and pressing a pen (or similar instrument) in to the bed of the patient's fingernail. A fully conscious patient would normally locate the pain and push it away, however a patient who is not alert and who has not responded to voice (hence having the test performed on them) is likely to exhibit only withdrawal from pain, or even involuntary flexion or extension of the limbs from the pain stimulus. The person assessing should always exercise care when performing pain stimulus as a method of assessing levels of consciousness, as in some jurisdictions, it can be considered assault. This is a key reason why voice checks should always be performed first, and the person assessing should be suitably trained. Sometimes seen noted as 'Unconscious', this outcome is recorded if the patient does not give any Eye, Voice or Motor response to voice or pain.