Glasgow Coma Scale
The GCS scores eye opening (1 to 4), verbal response (1 to 5), and motor response (1 to 6) for a total of 3 to 15. A score of 8 or less indicates severe injury and typically requires airway management. Reassess the GCS repeatedly to detect trends.
Signs of Increased Intracranial Pressure
Cushing's triad includes hypertension, bradycardia, and irregular respirations. Other signs are unequal pupils, posturing, and declining level of consciousness. These indicate possible herniation and need aggressive intervention.
Prehospital Priorities
Prevent hypoxia and hypotension, which dramatically worsen outcomes. Maintain SpO2 above 94 percent and a systolic blood pressure of at least 90 mmHg in adults. Ventilate only to maintain normal end-tidal CO2, and reserve hyperventilation for signs of herniation.