GLASGLOW COMA SCALE
Glasglow coma scale is the neurological scale that aims to give a reliable, objective way of recording the concious state of the person for initial as well as subsequent assessment.
It is the best predictor of neurological out come.A patient is assessed against the criteria of the scale and the resulting points give a patient score between 3(indicating deep unconciousness) and 14 (original scale) or 15 (the more widely used modified and revised scale)
The scale was published in 1974 by Graham Teasdale and Bryan J.Jennett, professors of neurosurgey at the University of Glasglow’s Institute of Neurological Science at the city Southern General Hospital.
Uses:
· GSC is initially used to assess the level of conciousness after head injury
· Now,GCS assessment is done by First Aid,emergency care givers,and doctors as being appicable to all acute medical and trauma patients
· In hospitals,it is also used in monitoring chronic patients in intensive care for assessing improvent of the condition of patients
What do the score mean??
v A high score of 15 – patient is fully alert,well oriented ,no loss of conciousness
v GCS of 13-minor head injury
v Score of 9-12 =moderate head injury
v Score of 8 or less=a level of coma and indicates need for standard nursing care;severe head injury
v A score of 3 is the lowest score indicating deep coma
Glasglow Coma Scale
1. Eye opening response(E)
§ Doesn’t open the eyes…………………………………………………………...1
§ Opens eyes in response to painful stimuli……………………………...…2
§ Opens eyes in response to voice……………………………………………...3
§ Open eyes spontaneously………………………………………………….……4
2. Best verbal response(V)
§ Makes no sounds…………………………………………………………………...1
§ Incomprehensible sounds…………………………………………………….…2
§ Utters inappropriate words………………………………………………….…3
§ Confused ,disoriented………………………………………………………….…4
§ Normal oriented conversation………………………………………………...5
3. Best motor responses(M)
§ No motor response………………………………………………………......…...1
§ Extension to painful stimuli…………………………………………….......…2
§ Abnormal flexion to painful stimuli………………………………........…..3
§ Withdrawl/flexion from painful stimuli…………………………….........4
§ Localised painful stimuli……………………………………………….....……5
§ Obeys command…………………………………………………………....……6
Assessment of Glasglow Coma Scale(GCS)
1) Assess the patient’s eye opening.A total points of 4 points may be given for eye opening.A patient who opens their eyes spontaneously such as an alert patient sitting in a chair would be scored as 4.
But if the patient is asleep or lying with the eyes closed but opens them upon command ,a 3 is awarded .
If the patient open their eyes to painful stimulus,such as running the tip of the blunt scissor along the bottom of the foot or a pinch,the patient is scored a 2.
A patient who doesn’t open their eye no matter what is;given as 1.Some patient may rouse if a very bright penlight is held a few inches from their eyes in order to induce a pain.
2) Ask the patient question or engaged in normal routine conversations to assess the verbral response.A person who engage in normal appropriate conversation would be given as 5 on GCS.
A patient who makes appropriate conversation but is confused; such as an Alzhiemher’s patient would be scored as 4.
The patient who makes inappropriate conversation,such as answering a question as an entirely different subject,would be given as 3.
If the patient cannot make conversation but instead has very grabbled speech or makes incomprehensible sounds, they could be given a 2.
The patient who is unable to speak or makes any sounds for any reasons, such as being on ventilator with a breathing tube in their mouth, would be given a 1.
3) If the patient is lying still , ask him to wiggle his feet or raise his left arm and asses the response. A patient who moves arm and less either spontaneously or on command is given a 6.
If the patient displays purposeful movement with a painful or unpleasent stimulus; such as trying to push it away the patient is given a 5.
The patient who only withdraws away from pain and no other response is given a 4
A score of 4 is given to the patient demonstrating decorticate posturing(in which is adduction of arm,internal rotation of shoulder,pronation of fore arm and flexion of wrist)
If the patient is in the decerebrate posture (the extremities are turn away from the body, abduction of arms,external rotation of the shoulder,supination of fore arm,extension of the wrist),the score is 2
The lack of any movement or posturing is given as 1
4) Record the GCS finding in the patient’s chart.Assess with routine physical assessment or whenever a change in GCS is noted.Report the findings to the physician as indicated.
Limitations for assessin Glasglow Coma Scale
1. The medical assessment cannot score the patient’s verbral responses if:
· The patient has drunk alcohol.Alcohol makes the speech hard to understand
· Presence of ET endotracheal tube)in the throat to help him breath.ET tube makes talking difficult.
· Person, who was given medicines to decrease pain and swelling.The medicine makes him too sleepy to talk.
2. The medical assessment cannot score how well the person opens his eyes if his eyes are swollen shut from the injury.
3. The medical assessment cannot score the person’s body movement if injury cause pain with movement or makes the person unable to move.
4. GCS doesnot check if the person can learn and remember new things.A person’s ability to form new memories is important in helpin care giverss to predict recovery after Traumatic Brain injury.
*Note:for children below 36 month (where the verbral response of even a healthy child would be expected to be the poor ).Consequently Paediatric Glasglow Coma Scale ,a separate yet closely related scale ,was developed for assessing younger children.
References:
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