兒童意識狀態紀錄表 (二到五歲) 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
		To verbal 3
		To pain 2
		None 1
	Best Verbal Response	Appropriate word & phrase 5
		Inappropriate words 4
		Persistent cries or scream 3
		Grunt 2
		No response 1
	Best Motor Response	Obey 6
		Localize pain 5
		Flexion-withdraw 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