Thursday, October 6, 2011

Glasgow Coma Scale

-GCS was initially used to assess level of consciousness after head injury, and the scale is now used by first aid, EMS, and doctors as being applicable to all acute medical and trauma patients. In hospitals it is also used in monitoring chronic patients in intensive care
-GCS is used as part of several ICU scoring systems, including APACHE II, SAPS II, and SOFA, to assess the status of the central nervous system. A similar scale, the Rancho Los Amigos Scale is used to assess the recovery of traumatic brain injury patients.

-Limitations & Solutions:

1) Tracheal intubation and severe facial/eye swelling or damage make it impossible to test the verbal and eye responses --> In these circumstances, the score is given as 1 with a modifier attached e.g. 'E1c' where 'c' = closed, or 'V1t' where t = tube. A composite might be 'GCS 5tc'. This would mean, for example, eyes closed because of swelling = 1, intubated = 1, leaving a motor score of 3 for 'abnormal flexion'. Often the 1 is left out, so the scale reads Ec or Vt.

2) Children, especially below the age of 36 months (where the verbal performance of even a healthy child would be expected to be poor) --> Consequently the "Pediatric Glasgow Coma Scale", a separate yet closely related scale, was developed for assessing younger children, it includes:

Best eye response: (E)
4.Eyes opening spontaneously
3.Eye opening to speech

2.Eye opening to pain

1.No eye opening

Best verbal response: (V)

5.Smiles, oriented to sounds, follows objects, interacts.

4.Cries but consolable, inappropriate interactions.

3.Inconsistently inconsolable, moaning.

2.Inconsolable, agitated.

1.No verbal response.

Best motor responses: (M)

6.Infant moves spontaneously or purposefully

5.Infant withdraws from touch

4.Infant withdraws from pain

3.Abnormal flexion to pain for an infant (decorticate response)

2.Extension to pain (decerebrate response)

1.No motor response

Any combined score of less than eight represents a significant risk of mortality

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