The Glasgow Coma Scale is a neurological scale used to assess a person's level of consciousness after brain injury. It was developed in 1974 by Graham Teasdale and Bryan Jennett. The scale consists of 3 components - eye opening, verbal response, and motor response - each of which are assigned a score between 1-5. The scores from each component are added to give a total score between 3-15, with lower scores indicating a worse level of consciousness. The Glasgow Coma Scale provides a standardized measure for initial assessment and ongoing monitoring of patients with brain injuries.

1. Short Note Discussion
To

2. Dr. Md. Shohidullah
Resident (Phase A)
Dept. of Orthopaedics
Bangabandhu Sheikh Mujib Medical University

3. Glasgow coma scale is a neurological scale that aims
to give a reliable,objective way of recording the
consciousness level of a person for initial assessment
as well as subsequent management.

4. ● The glasgow coma scale was published in 1977 by
Graham Teasdale and Bryan J. Jennett.
● They are Professors of Neurosurgery at Institute of
Neurological Science in the University of Glasgow.

5. It composed of 3 components--
-Eye opening
-Best verbal response
-Best motor responce

6. Responce Score
Spontaneously 4
To verbal command 3
To pain stimulus 2
Do not open 1

7. Responce Score
Normal oriented conversation 5
Confused 4
Inappropriate/words only 3
Sounds only 2
No sounds 1
Intubated patient T

8. Responce Score
Obeys command 6
Localise to pain 5
Withdrawal/flexion 4
Abnormal flexion 3
Extension 2
No motor responce 1

9. Type Score
Mild head injury 13 - 15
Moderate head injury 9 – 12
Severe head injury 3 – 8
-Best possible score is 15/15
-Worst possible score is 3/15

10. Central pain stimulus:
-Trapizium squeeze
-Supraorbital pressure
-Jaw margin pressure
Peripheral pain stimulus
-Fingure pressure

13. Obeys commands:
-Highest level of motor response
-Accurate response to instruction
-raise eyebrows
-stick out tongue
-Let go

14. Localising pain:
Response to pain stimulus - moves hand to the
point of stimulation
-Supra orbital pressure
-Jaw margin pressure
-Trapezius squeeze
-Sternal rub

15. Withdrawal from Pain:
-Normal flexion in response to central pain
Stimuli, but failing to locate source of pain.
-Pulls limb away from painful stimulus.

16. Abnormal flexion(Decorticate response):
-Adduction of arm
-Internal rotation of shoulder
-Pronation of forearm
-Flexion at elbow and wrist
Extension(Decerebrate response):
-Abduction of arm
-External rotation of shoulder
-Supination of forearm
-Extension of elbow and wrist

18. If a pt localise to pain on one side and extend to pain on
other side, then the motor score is 5/6
If a pt opens eye to pain stimulation,say occasional words
and flex to pain then the GCS is 9/15 (E2,V3,M4)
If a pt is intubated,then the verbal score is T
If a pt is intubated,opens eye to speech,and localise to
pain,then the GCS is 7T/15

20.  Acute brain damage:
Traumatic injuries
Vascular injuries
Infections
Metabolic disorders:
Hepatic failure
Renal failure
Hypoglycemia
Diabetic ketoacidosis
Toxin ingestion
Post anaesthesia.

21. Assess initial level of consciousness
Quantifies level of consciousness
Assess changes in level of consciousness
Helps in treatment
Predict outcome

22. GCS less than 13 at any time
GCS 13 0r 14 at 2 hours
Focal neurologival deficit
Seizure
Vomiting
Suspected open,depressed or basal skull fracture

23. Eye opeing:
1-5 year 0-1 year Score
Spontaneously Spontaneously 4
To command To shout 3
To pain To pain 2
No eye opening No eye opening 1

24. Best verbal response:
1-5 years 0-1 year Score
Appropriate words,
phrases
Coos, babbles, smiles 5
Inappropriate words Cries 4
Cries, screams Inappropriate cries,
screams
3
Grunts Grunts 2
No responce No responce 1

25. Best motor response:
1-5 years 0-1 year Score
spontaneous Same 6
localizes pain Same 5
Flexion/withdrawal Same 4
abnormal flexion Same 3
extension Same 2
No responce Same 1
Same

26. There are some problems in using Glasgow Coma Scale
-Misunderstood
-Misused
-Improper implication.
So…..learning,training and practice are
necessary to the proper application of this
scale.