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Glasgow Coma Scale
The GCS adds three components for a total between 3 and 15:
| Component | Range | Top score means |
|---|---|---|
| Eye opening | 1โ4 | opens eyes spontaneously |
| Verbal response | 1โ5 | oriented |
| Motor response | 1โ6 | obeys commands |
- The lowest possible score is 3, not 0 โ every component starts at 1.
- A total of 8 or less indicates a severely decreased level of consciousness and a patient who may not protect their own airway.
- Score the best response you can elicit, and trend it. A falling GCS matters more than any single number.
Rule of nines
A quick estimate of the body surface area burned, by region. Adult proportions:
| Region | Adult | Infant |
|---|---|---|
| Head and neck | 9% | 18% |
| Each arm | 9% | 9% |
| Front of trunk | 18% | 18% |
| Back of trunk | 18% | 18% |
| Each leg | 18% | 13.5% |
| Genital area | 1% | 1% |
- Children have larger heads and smaller legs in proportion; the infant column above shows the usual adjustment.
- Superficial burns (reddened skin only) are not counted in the total.
- For scattered or irregular burns, the palm of the patient's hand is roughly 1% of their body surface.
Apgar score
Five signs, each scored 0โ2, at 1 and 5 minutes after birth, for a total from 0 to 10:
| Sign | Looks at |
|---|---|
| Appearance | skin color |
| Pulse | heart rate (absent, under 100, 100 or more) |
| Grimace | reflex irritability |
| Activity | muscle tone |
| Respiration | breathing effort |
The exam trap: resuscitation of a newborn who is not breathing adequately never waits for the one-minute Apgar. You act on breathing and heart rate immediately.
All three are free to use as interactive calculators โ GCS, rule of nines and Apgar โ with the interpretation shown beside the number.