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Glasgow Coma Scale (GCS)
– The fundamentals for
nurses
Dr Ravi Dadlani
Consultant Neurosurgeon
05th October 2015
Past: Background
• In 1974
– (Sir) Graham Teasdale (1940 - )
– Bryan Jennett (1926-2008)
Neurosurgeons in Glasgow
Clinical Implications I
• Severity of Head Injury (HI):
– 13-15 (mild HI)
– 9-12 (moderate HI)
– < 8 (severe HI)
Clinical Implications II
• Prognostic Significance
• Glasgow Outcome Score (GOS)
GCS – The Stimuli
• 1. Spontaneously – No stimuli
• 2. To Verbal stimuli
• 3. To painful stimuli
Where do you give painful stimuli?
1. Supra-orbital notch ---- Central stimulation
2. Sternal rub - A V O I D
3. Nipple
4....
GCS – The responses
• Patients may localize or exhibit a variety of
responses, asymmetry is important
• GCS is about the r...
Glasgow Coma Scale (GCS)
Best eye
response (E)
Best verbal
response (V)
Best motor
response (M)
4 spontaneously 5 Oriented...
How are the components assessed?
• Eyes Opening:
– Score 4: eyes open spontaneously;
– Score 3: eyes open to speech;
– Sco...
How are the components assessed?
• Verbal Response:
– Score 5: orientated; must be able to tell you their full
name, the p...
How are the components assessed?
Best Motor Response:
• Score 6: obeys commands. The patient can perform two
different mov...
M5- Attempts to remove the offending
painful stimuli PURPOSIVE MOVEMENT
M4- Normal flexion – Withdrawal
SEMI-PURPOSIVE MOV...
Abnormal flexion and extension to
pain
GCS – The Stimuli
• 1. Spontaneously – No stimuli E4 M V
• 2. To Verbal stimuli E3 M V4,V3,V2
• 3. To painful stimuli E2,E...
The pediatric scale
Glasgow Coma Score Video
• GCS video
Resources
• www.glasgowcomascale.org
GCS - The fundamentals for nurses and nursing students
GCS - The fundamentals for nurses and nursing students
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GCS - The fundamentals for nurses and nursing students

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The first in a series of fundamental classes in neuro nursing.

Published in: Health & Medicine

GCS - The fundamentals for nurses and nursing students

  1. 1. Glasgow Coma Scale (GCS) – The fundamentals for nurses Dr Ravi Dadlani Consultant Neurosurgeon 05th October 2015
  2. 2. Past: Background • In 1974 – (Sir) Graham Teasdale (1940 - ) – Bryan Jennett (1926-2008) Neurosurgeons in Glasgow
  3. 3. Clinical Implications I • Severity of Head Injury (HI): – 13-15 (mild HI) – 9-12 (moderate HI) – < 8 (severe HI)
  4. 4. Clinical Implications II • Prognostic Significance • Glasgow Outcome Score (GOS)
  5. 5. GCS – The Stimuli • 1. Spontaneously – No stimuli • 2. To Verbal stimuli • 3. To painful stimuli
  6. 6. Where do you give painful stimuli? 1. Supra-orbital notch ---- Central stimulation 2. Sternal rub - A V O I D 3. Nipple 4. Trapezius squeeze ---- Central stimulation 5. Nail bed ---- Peripheral stimulation 6. Retromandibular /Styloid process (behind the jaw)---difficult to apply and interpret
  7. 7. GCS – The responses • Patients may localize or exhibit a variety of responses, asymmetry is important • GCS is about the responses
  8. 8. Glasgow Coma Scale (GCS) Best eye response (E) Best verbal response (V) Best motor response (M) 4 spontaneously 5 Oriented 6 Obeys commands 3 to speech 4 Confused 5 Localizes to pain 2 to pain 3 Inappropriate words 4 Withdraws from pain 1 No eye opening 2 Incomprehensible sounds 3 Flexion in response to pain 1 None 2 Extension to pain 1 No motor response 1976
  9. 9. 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, for example trapezium squeeze (caution if applying a painful stimulus); – 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
  10. 10. 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 or ET tube
  11. 11. How are the components assessed? Best Motor Response: • Score 6: obeys commands. The patient can perform two different movements; primative 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.
  12. 12. M5- Attempts to remove the offending painful stimuli PURPOSIVE MOVEMENT M4- Normal flexion – Withdrawal SEMI-PURPOSIVE MOVEMENT M3 – Abnormal flexion– Decortication REFLEX NON-PURPOSIVE MOVEMENT M2- Extensor REFLEX NON-PURPOSIVE MOVEMENT
  13. 13. Abnormal flexion and extension to pain
  14. 14. GCS – The Stimuli • 1. Spontaneously – No stimuli E4 M V • 2. To Verbal stimuli E3 M V4,V3,V2 • 3. To painful stimuli E2,E1 M5-1 V1,V2
  15. 15. The pediatric scale
  16. 16. Glasgow Coma Score Video • GCS video
  17. 17. Resources • www.glasgowcomascale.org

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