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GLASGOW COMA SCALEPRESENTATION

BY: CIZMAN M.Q AKA JET BLACK/CIZMAN BOZKIL

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Introduction to the GCS• Neurological assessment tool

• Published in 1974 by Jennett and Teasdale

• Aim of the tool: determining the severity of a patients’ brain dysfunction

• Originally intended for post head injury patients, now a tool for all acute medical and trauma patients.

• It is widely used to assess level of consciousness in a variety of clinical settings and is a recommended observation tool in all patients with head injuries.

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Scoring system

• A patients assessment will result in a score between three; no response and fifteen; fully alert and responsive.

• The score out of 15 is derived from the three tests on eye opening, verbal response and motor response. Alongside this, pupil response, neurological limb response and basic vital signs are also recorded.

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How is the score composed?

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How are the components assessed?

• Eyes Opening:– Score 4: eyes open spontaneously;– Score 3: eyes open to speech;– Score 2: eyes open in response to pain only, – Score 1: eyes do not open to verbal or painful

stimuli.– ‘C’ is recorded for patients unable to open eyes

due to for example swelling

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How are the components assessed?

• Verbal Response:– Score 5: orientated; must be able to tell you their full name,

the place in which they are and the date. If the patient doesn’t know any of these it is assumed they are confused.

– Score 4: confused; not able to answer orientation questions– Score 3: inappropriate words; swearing, aggression,

unrelated words to the questions being asked– Score 2: incomprehensible sounds;– Score 1: no verbal response. – ‘D’ is marked for patients who are dysphasic (unable to

speak coherently. ‘T’ is marked for those with a tracheostomy

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How are the components assessed?Best Motor Response:• Score 6: obeys commands. The patient can perform two

different movements; primitive reflexes should not be tested• Score 5: localises to central pain. The patient does not

respond to a verbal stimulus but purposely moves an arm to remove the cause of a central painful stimulus

• Score 4: normal flexion. The patient flexes or bends the arm towards the source of the pain but fails to locate the source of the pain (no wrist rotation)

• Score 3: abnormal flexion to pain • Score 2: extension to pain• Score 1: no response to painful stimuli.

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Classification of Brain InjuryAccording to Glasgow Coma Scale

(GCS)

MILDGCS 13-15

MODERATEGCS 9-12

SEVERE GCS 3-8

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Causes of a decreased conscious level

HypoxaemiaHypotensionHypercapniaHypoglycaemiaDrugs (sedatives,opiates,overdoses,alcohol)SeizuresHead injury

Intracranial haemorrhageCerebral infarctionIntracranial infection HypothermiaHyperthermiaHypothyroidismHepatic encephalopathy

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Early Signs & Symptoms of Raised ICP

• Deterioration in level of consciousness (LOC)

• Confusion• Restlessness• Lethargy• Headache• Pupillary dysfunction• Motor & sensory deficits• Cranial nerve palsy

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Transient Signs & Symptoms of Raised ICP

• Decreased LOC• Pupil abnormalities• Visual disturbance• Motor dysfunction• Headache & vomiting• Aphasia• Changes in respiratory pattern• Changes in vital signs

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Late Signs & Symptoms of Raised ICP

• Continued deterioration in level of consciousness

• Hemiplegia, decortication & decerebration

• Alteration in vital signs

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Summary• A decreased level of consciousness is common in acute

illness• Hypoxaemia,hypotension, hypoglycaemia are common

causes of coma• A decreased consciousness level may cause airway

obstruction and loss of protective airway reflexes

• Failure to identify early signs and symptoms of raised intracranial pressure puts the patient at great risk, and opportunity for intervention may be lost

• Potential if untreated a respiratory or cardiac arrest

• Treatment of a deteriorating consciousness is focused on care of the airway, breathing, circulation disability and exposure

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Thank you for listening