 To calculate the patient's level of consciousness, we often have to calculate the Glasgow Column Scale, or the GCS. If the patient responds spontaneously or to verbal stimuli, we can easily calculate the GCS by looking for their verbal, motor, and eye responses. If the patient does not respond to those, we will deliver a painful stimuli to assess their best scores. There are different ways to do this. One is the sternal rub. Ensure there is no open wound or flail chest on the patient. Make a fist. Push downwards on the patient's sternum for 3-4 seconds. Another one is to deliver a painful stimulus on their nail. Take a pen. Roll the body of the pen downwards on the nail bed for 2-3 seconds. During both painful stimuli, record the patient's best responses in eye, motor, and verbal.