1a. Level of Consciousness: The investigator must choose a response, even if a full evaluation is prevented by such obstacles as an endotracheal tube, language barrier, orotracheal trauma/bandages. A 3 is scored only if the patient makes no movement (other than reflexive posturing) in response to noxious stimulation.0 = Alert; keenly responsive1 = Not alert, but arousable by minor stimulation to obey, answer, or respond2 = Not alert, requires repeated stimulation to attend, or is obtunded and requires strong or painful stimulation to make movements (not stereotyped)3 = Responds only with reflex motor or autonomic effects or totally unresponsive, flaccid, areflexic

This passage appears to be a scale or guide for assessing a patient's level of consciousness, likely used in a medical or clinical setting. Here's a step-by-step breakdown:

1. The investigator must choose a response. This means that the person conducting the assessment must make a decision about the patient's level of consciousness, even if there are obstacles that prevent a full evaluation. These obstacles could include an endotracheal tube (a tube inserted into the patient's windpipe for ventilation), a language barrier, or oral trauma/bandages.

2. A score of 3 is only given if the patient makes no movement other than reflexive posturing in response to noxious (unpleasant or harmful) stimulation. This means that the patient is either only responding with reflex motor or autonomic effects, or is totally unresponsive, flaccid, and areflexic.

3. The other scores are as follows:

   • 0: The patient is alert and keenly responsive. This means they are fully conscious and able to respond quickly and effectively to stimuli.
   • 1: The patient is not alert, but can be aroused by minor stimulation to obey, answer, or respond. This means they are not fully conscious, but can be made to respond to simple commands or questions.
   • 2: The patient is not alert and requires repeated stimulation to attend, or is obtunded (dulled or less sharp) and requires strong or painful stimulation to make movements that are not stereotyped (repetitive or unvarying). This means they are less conscious and require more effort to respond, if they can respond at all.