GLASGOW COMA SCALE

Description: Graham Teasdale and Bryan J. Jennett first developed the Glasgow Coma Scale in 1974. At the University of Glasgow, these neurosurgery professors continued to develop important work in the field of head traumas, publishing Management of Head Injuries in 1981. The Glasgow Coma Scale (GCS) is an accurate neurological scoring system that provides a reliable and objective way of recording the state of consciousness of a person. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (the more widely used modified or revised scale). At first, the GCS was only intended to assess the level of consciousness of a person after a head injury but now in the modern settings, it is also used by first aid, EMS, and doctors to as well assess all acute medical and trauma patients. It is also useful in monitoring patients in the intensive care unit. Purpose: The GCS assesses the two aspects of consciousness:

Arousal or wakefulness: being aware of the environment; Awareness: demonstrating an understanding of what has been said.

The 15-point scale assesses the patients level of consciousness by evaluating three behavioral responses; the eye opening, verbal response, and motor response. Indications: Conscious/semi-conscious patient due to any reason Obvious or suspected HI Post neurosurgery or vascular surgery to carotid vertebral arterial Severe unexplained headache Neural impairment Prolonged epileptic seizure Drug overdose Limitations: Factors like drug use, alcohol intoxication, shock, or low blood oxygen can alter a patients level of consciousness. These factors could lead to an inaccurate score on the GCS. Procedure: Eye opening: Score 4 if patients eyes are open upon approaching the bed, or remain open when not spoken to. Score 3 if patients eyes open when spoken to or shouted at. Score 2 if patients eyes open after applying a central pain stimulus. Score 1 if patients eyes dont open at all. Put C if eye closed due to swelling. (1 point) Verbal response:

 Score 5 if patient knows who they are, the day, and where they are. Score 4 if patients responses to questions are incorrect, but appropriate. Score 3 if patients response to questions are inappropriate or irrelevant to question. Score 2 if patients response incomprehensible (eg moans). Score 1 if no response. Put T if patient scores 1 because theyre intubated. Motor response: Use the best response at time of assessment, normally arms, but may be legs. Score 6 if patient obeys simple commends. Ensure pateints hand squeeze is not grasp reflex by asking them to release their grip also. Score 5 if patient localises with hands/arms to sternal rub. Score 4 if patient withdraws hand, briskly, to nail bed pressure. Score 3 if patient has abnormal flexion to central pain stimulus (ie Decorticate posturing). Score 2 if patient extends to central pain stimulus (ie Decerebratye posturing). Score 1 for no movement. Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form "GCS 9 = E2 V4 M3 at 07:35". Generally, brain injury is classified as:

Severe, with GCS < 8 Moderate, GCS 812 (controversial) Minor, GCS 13.

Note: Document if patient has GCS of 3 due to paralysis or sedation. If eye closed due to swelling document C under eye opening. Docuement T for verbal response if patient intubated or has a tracheostomy. If motor response differs from R to L document R or L in appropriate boxes. Make note if patient is a quadriplegic/paraplegic. Responses to peripheral pain stimuli (nail bed pressure) may be possible even with a complete cord transection. Therefore peripheral stimulus is an inappropriate stimulus for assessing the GCS. PUPIL ASSESSMENT: Ask patient to open eyes or open them yourself. Are pupils equal in size and both round? Using pen torch, shine light into pupil. Does the pupil constrict briskly? Does theopposite pupil constrict? Check other pupil. Document pupil size in mm and reaction as negative, positive or sluggish.

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____ ________________________ Clinical instructor