The Glasgow Coma Scale (GCS) evaluates consciousness levels in patients with traumatic brain injury, comprising three categories: eye opening, motor response, and verbal response, with a scoring range of 3 to 15. A clinical case is presented involving a 64-year-old woman with hypertension who experienced a stroke, leading to brain stem death and subsequent discontinuation of life support. The document includes detailed scoring criteria for GCS and describes the patient's symptoms, examination findings, and test results.

1. GCS
Prepared by:
Ms Tissymol Thomas
GNM, B Sc (Nursing) M Sc. (Medical & Surgical)
Certified Internal Auditor (NABH 5th Edition)
Infection Preventation & Control (WHO)
Severe Acute Respiratory Infection –Treatment Facility (WHO)
Clinical Care Severe Acute Respiratory Infection (WHO)
nCOVID - 19 Awareness and Prevention Program (Apollo Med skill & NSDC)
MARIT- Managing emergency and rapid intervention and Treatment –Oxford Brookes University
BLS & ACLS (SCTE)
Nursing Superintendent-Ford Hospital & Research Centre
Academic Director: SKILLVERSITY COUNCIL OF TRAINING AND EDUCATION

2. Glasgow Coma Scale
The Glasgow Coma Scale (GCS) is
used to describe the general level of consciousness in
patients with traumatic brain injury (TBI) and to
define broad categories of head injury. [1] The GCS is
divided into 3 categories, eye opening (E), motor
response (M), and verbal response (V). The score is
determined by the sum of the score in each of the 3
categories, with a maximum score of 15 and a minimum
score of 3.

3. The three responses measuredare:
 Best motor response - maximum score of 6
 Best verbal response - maximum score of 5
 Eye opening - maximum score of 4.

4.  The lowest score for each category is 1, therefore the
lowest score is 3 (no response to pain + no verbalization +
no eye opening).
 A GCS of 8 or less indicates severe injury, one of 9-
12 moderate injury, and a GCS score of 13-15 is
obtained when the injury is minor.

5.  Grades of Best Motor Response
6 Carrying out request ('obeying command') -patient does
simple things you ask.
5 Localising response to pain.
4 Withdrawal to pain - pulls limb away from painful
stimulus.
3 Flexor response to pain - pressure on nail bed causes
abnormal flexion of limbs - decorticate posture.
2 Extensor posturing to pain - stimulus causes limb
extension - decerebrate posture. 1 No response to pain.

6.  Grades of Best Verbal Response
5 Oriented - patient knows who and where they are, and
why, and the year, season and month.
4 Confused conversation - patient responds in
conversational manner, with some disorientation and
confusion.
3 Inappropriate speech - random or exclamatory speech,
with no conversational exchange.
2 Incomprehensible speech - no words uttered, only
moaning.
1 No verbal response.

7.  Eye Opening
4 Spontaneous eye opening.
3 Eye opening in response to speech - that is, any speech
or shout.
2 Eye opening in response to pain. 1 No eye opening.

10.  PresentationA 64 year old woman with hypertension was admitted by her GP after
complaining of right-sided weakness. Over the next couple of days her condition worsened,
and four days later she appeared to suffer a serious stroke, following which she was completely
unresponsive. Tests confirmed brain stem death and permission was sought to switch off her
life support.
History
 The woman had a 10-year history of hypertension. When she noticed loss of sensation and loss
of power on her right side she went to her GP, who had her admitted.
 Examination
 Pulse was 80bpm, bp 154/80, normal heart sounds.
 A positive Babinsky sign was noted in her right foot.
 Moderate loss of power and sensation of limbs on right side.
 Weakness of right side of face, and dysarthria.
 Test results:
 No abnormal findings on CT scan or EEG.
 Progression She showed no improvement of her right-sided weakness after admission to
hospital. A small stroke was suspected, but no lesion could be seen on the CT scan. Four days
after admission she deteriorated. Her Glasgow coma scale rating was 3. She was totally
unresponsive. An MRI showed a suspected brain stem haemorrhage and a small established
infarct in the left parietal lobe.
 When tests showed brain stem death, permission was sought from her family to switch off her
life support, and she died 6 days after admission.

11. REFERENCES
1.https://www.le.ac.uk/pa/teach/va/case_1/gcs.html
2. https://emedicine.medscape.com
3.Wikipedia

12. THANK YOU