recent updated GCS

1. GLASGOW COMA SCALE
Dr. Awaneesh Katiyar M.Ch
Trauma Surgery and Critical care
AIIMS, Rishikesh, India

2. Consciousness
• William James (1890) defined - as awareness of oneself and
environment.

3. Before 1974
Consciousness was assessed by
terms
• Coma ,
• Unconscious,
• Semiconscious,
• Drowsy etc.

4. 1974 - Graham Teasdale and Bryan Jennet
Eye opening ,
Verbal ,
Motor
Graham Teasdale and Bryan Jennet
The Lancet , July 13, 1974

5. From original article - 1974

6. Same authors – 1976
Assessment and Prognosis
of Coma After Head Injury

7. A structured approach to assess GCS –
G. Teasdale 2018

8. GCS
Eye opening Verbal response Motor response
Spontaneous 4 Orientated 5 Obeys commands 6
To sound 3 Confused 4 Localizing 5
To pressure 2 Words 3 Normal flexion 4
none 1 Sounds 2 Abnormal flexion 3
None 1 Extension 2
None 1
NT- Non testable , Range 3-15
eye opening
verbal response
motor response
https://www.glasgowcomascale.org/

9. How to assess - GCS

10. Site for stimulus- pressure

11. Trapezius pinch Supraorbital notch

12. Eye opening

13. Eye Opening

14. Verbal response

15. Verbal response
Best Verbal Response
Score Age >5 Years Age 2-5 Years Age 0-2 Years
5 Oriented and converses Appropriate words Cries appropriately
4 Disoriented and converses Inappropriate words Weak Cries
3 Inappropriate words; cries Screams
Inappropriate
crying/screaming
2 Incomprehensible sounds Grunts Grunts
1 No response No response No response

16. Best motor response

17. Pediatric Age
Best Motor Response
Score Age 1 Year or Older Age 0-1 Year
6 Obeys command
5 Localizes pain Localizes pain
4 Flexion withdrawal Flexion withdrawal
3 Flexion abnormal (decorticate)
Flexion abnormal
(decorticate)
2 Extension (de-cerebrate)
Extension
(decerebrate)
1 No response No response

18. Flexion
Assessment
M4
Normal flexion
Rapid
Variable
Arm away from body
wrist extend/neutral
shoulder abduct
M3
Abnormal Flexion
Slow
Stereotyped
Arm across chest
Forearm rotates
Thumb clenched
Leg extends
Adduct shoulder

19. M2 vs M3
M3
Abnormal Flexion
Slow
Stereotyped
Arm across chest
Forearm rotates
Thumb clenched
Leg extends
Adducted shoulder
M2
Extesion
elbow hyperextension
pronate with
adducted shoulder

21. Factor Affecting GCS Assessment- NT
Eye opening Verbal Motor
Raccoon eye/ edema Hard of hearing / hearing loss Limb injury/ splinted limb.
Orbital injury Tracheostomy paralysis
B/L 3rd nerve injury Maxillofacial trauma

22. In Quadriparesis/ splinted leg.
• If patients eye opening and Verbal response are normal –
almost always motors response will be normal.
• If patient able to show - his/her tongue, verbalizing normally –
fully conscious.

23. Important points
• Eye opening response – pain stimulus should be given over nail
/ shoulder pinch – to avoid grimace causes closure of eyes.
• Decorticate patient(persistent vegetative) may reacting visually
to people around them spontaneously – subcortical reflex.

24. Thank You ………….
drawaneeshkatiyar@gmail.com