NEURO STATUS • RAPID RECALL

GCS: score the best response

Start high, move down, stop at the first response the patient can perform.

LIVE TOTAL

— / 15

E— + V— + M—

Select all 3

PATIENT RESPONSE

Tap E, V, or M

For each branch, choose the patient’s best observed response.

Documentation: write the components, not just the total—e.g. E4 V3 M4 = 11. If intubated, verbal is V-NT, not automatically V1.

60-SECOND CASE

Spontaneous eyes, random recognizable words, pulls arm away from pain

What is the total GCS?

E4 + V3 + M4 = 11. “Recognizable words” earns V3; pulling away without targeting the stimulus earns M4.

Two-second discrimination

M5 Localizes
Hand moves toward the painful stimulus to remove it: purposeful.

M4 Withdraws
Limb moves away from pain without targeting it: reflex-like.

THE THREE CEILINGS

Eyes 4 • Verbal 5 • Motor 6

Think 4–5–6: the patient opens, speaks, then acts.

Eyes: S-V-P-N
Spontaneous 4 → Voice 3 → Pain 2 → None 1.

Verbal: O-C-W-S-N
Oriented 5 → Confused 4 → inappropriate Words 3 → incomprehensible Sounds 2 → None 1.

Motor: O-L-W-F-E-N
Obeys 6 → Localizes 5 → Withdraws 4 → abnormal Flexion 3 → Extension 2 → None 1.

Severity bands

13–15Mild

9–12Moderate

3–8Severe

Exam/clinical anchor: GCS ≤8 indicates severe impairment and often prompts airway protection assessment—never use the number alone without clinical context.

GCS Decision Tree