The initial rapid neurological evaluation includes pupillary size and reaction and the patient's response to verbal and/or painful stimuli. The Glasgow Coma Scale (GCS) is based on three behavioral responses: eye opening, best verbal response, and best motor response ( Table.!). As a general rule, the head injury is mild with a GCS of 13 to 15, moderate with a GCS of 9 to 12, and severe with a GCS of 3 to 8.
An altered level of consciousness indicates the need for immediate re-evaluation of the patient's oxygenation, ventilation, and perfusion. Alcohol and/or other drugs may also alter the level of consciousness. However, if hypoxia and hypovolemia have been ruled out, changes in the level of consciousness should be considered to be due to trauma of the central nervous system until proven otherwise.
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