兒童意識狀態紀錄表 第_{____}頁

姓名 病例號碼 床號 年齡

日 期
時 間
C O M A S C A L E	Eyes Open	Spontaneously 4
		>1yr to verbal <1yr to shout 3
		To pain 2
		None 1
	Best Verbal Response	> 5 yr	Oriented & Converses 5
			Disoriented & converses 4
			Inappropriate words 3
			Incomprehensible sounds 2
			No response 1
		2 | 5 yr	Appropriate word & phrase 5
			Inappropriate words 4
			Persistent cries or scream 3
			Grunt 2
			No response 1
		0 | 2 yr	Smile,coos appropriate 5
			Cries, consolable 4
			Persistent inappropriate crying/screaming 3
			Grunt,agitated, restless 2
			No response 1
	Best Motor Response	>1yr Obey/< 1yr spontaneous 6
		>1yr Localize pain/<1 yr withdraw to touch 5
		>1yr Flexion-withdraw/<1yr withdraw to pain 4
		Flexion-abnormal,Decroticated 3
		Extension, decerebrated 2
		No response 1
Pupil Size in mm		Pupil + react - none C close		R	size
					reaction
				L	size
					reaction
		M O T O R		A R M S	Muscle Power=5
					Muscle Power=4
					Muscle Power=3
					Muscle Power=2
					Muscle Power=1
				L E G S	Muscle Power=5
					Muscle Power=4
					Muscle Power=3
					Muscle Power=2
					Muscle Power=1