The Glasgow Coma Scale (GCS) is a widely used tool for measuring levels of consciousness and neurological function, assessing eye, verbal, and motor responses to various stimuli. It assists healthcare providers in evaluating conditions that lead to decreased consciousness, such as head injuries or other medical emergencies. Updates to the GCS, including the introduction of GCS-P, enhance the assessment of brain function by incorporating pupil reactivity as an additional metric.

1. PT: TURKI ELNIEL

2. LECTURE CONTENTS
• What is the Glasgow Coma Scale?
• What is consciousness?
• When is the Glasgow Coma Scale used?
• What does the Glasgow Coma Scale measure?
• How does the Glasgow Coma Scale work?
• GCS-T
• GCS-P
• GCS ranges for head injuries
• Simple classification according to GCS score
• A note from Cleveland Clinic

3. WHAT IS THE GLASGOW COMA
SCALE?
• The Glasgow Coma Scale is a tool that healthcare providers use to
measure decreases in consciousness. The scores from each section of
the scale are useful for describing disruptions in nervous system
function and also help providers track changes. It’s the most widely
used tool for measuring comas and decreases in consciousness.
• The Glasgow Coma Scale (GCS) is a system to “score” or measure how
conscious you are. It does that by giving numbered scores for how
awake you are, your level of awareness and how you respond to
basic instructions.

4. WHAT IS CONSCIOUSNESS?
-In the medical context, consciousness has three requirements. To be
conscious, you have to be:
• Awake: This includes whether or not you have the ability to wake up because
of voice or touch. That’s what makes a coma different from just being asleep.
• Alert: This is how responsive you are to people talking to you and if you’re
able to understand what’s happening in your immediate surroundings.
• Oriented: This means you know who you are, where you’re at, what day it is
and other details related to the here and now.

5. WHEN IS THE GLASGOW COMA SCALE USED?
• Healthcare providers can use the GCS as part of a neurological
exam. It’s also useful for any situation where you might have a
decrease in how conscious you are. That includes injury-related
conditions like concussions and traumatic brain injuries.
• The scale also can help with conditions that don’t involve
injuries, such as low blood sugar (hypoglycemia), poisoning or
after a seizure.

6. WHAT DOES THE GLASGOW COMA SCALE
MEASURE?
-The Glasgow Coma Scale has three categories that apply to a neurological exam. Most of
them apply to your brain itself, but some can also involve your spinal cord and nerves
throughout your body:
• Eye response: This relates to how awake and alert you are.
• Motor response: This part is about how well your brain can control muscle
movement. It can also show if there are any issues with the connections between your
brain and the rest of your body.
• Verbal response: This tests how well certain brain abilities work, including thinking,
memory, attention span and awareness of your surroundings.

7. HOW DOES THE GLASGOW COMA SCALE WORK?
• To get your Glasgow Coma Scale score, providers take the scores from the
three categories of the GCS and add them together. A healthcare provider
will test each of the three categories in multiple ways. An example of this
is testing your verbal response by asking you a few different questions,
such as what day of the week or date it is or what city you're in currently.
• One of the best uses of the GCS is to track changes in your level of
consciousness. Healthcare providers will often repeat a neurological exam
at regular intervals to check for and document any changes in your GCS
score.

8. AREA OF PRESSURE IN GCS TEST
• Nail beds: Your fingernails and toenails are pressure-sensitive.
Providers often push on one or more of them during a neurological
exam to test if your body reacts reflexively to the pressure.
• Trapezius muscle: This muscle connects your shoulder to the center
of your neck and back. It’s an easy-to-reach muscle to check for a
pressure reflex.
• Supraorbital notch: This is a small groove in the bone of your skull
just above your eye and just below your eyebrow.

9. Eye response.
This is mainly about how awake you are. If you’re
unconscious, it measures the level of unconsciousness by
testing reflex responses to pressure. Pressure here means
something like a pinch or a poke. It should be just enough to
cause minor, momentary discomfort but not injury.

10. Eye response
score
Score meaning
4
(Spontaneously)
patient can open his/her eyes and keep them open by himself.
3
(To verbal command )
Patient only open his/her eyes when someone tells you to do so. Patient
eyes stay closed otherwise.
2
(To pressure )
Patient eyes only open in response to feeling pressure.
1
(No eye opening )
Patient eyes don’t open for any reason.

11. Verbal response
A provider checks this by asking you questions that test your
memory, thinking ability and your awareness of the world
around you. Your provider can also use this to see if there are
any brain or nerve problems affecting control of your face
and mouth.

12. Verbal response
score
Score meaning
5
(Oriented )
Patient oriented. He/she can correctly answer questions about who you are, where
you’re at, the day or year, etc.
4
(Confused)
Patient confused. He/she can answer questions, but the answers show that He/she
is not fully aware of what’s happening.
3
(Inappropriate words )
Patient can talk and others can understand him/her words, but the responses to
questions don’t make sense.
2
(Incomprehensible sounds)
Patient can’t talk and can only make sounds or noises.
1
(No verbal response)
You can't speak or make sounds.

13. Motor response
This part can reveal any issues with the connections
between your nerves, spinal cord and brain. It also tests
your brain’s ability to control muscle movement and how
well you can understand and follow instructions.

14. Motor (movement) response
score
Score meaning
6
(Obeys commands )
Patient follow instructions on how and when to move.
5
(Localizes pressure )
Patient intentionally move away from something that presses on patient.
4
(Withdrawal from pressure )
Patient only move away from something pressing on him/her as a reflex.
3
(Flexion to pressure)
Patient flex muscles (pull inward) in response to pressure.
2
(Extension to pressure )
Patient extend muscles (stretch outward) in response to pressure.
1
(No motor response )
Patient don’t move in response to pressure.

18. GCS-T
Patients who are intubated or in trach (without speaking
valve) are unable to speak, and their verbal score cannot
be assessed. They are evaluated only based on eye opening
and motor scores, and the suffix T is added to their score to
indicate intubation. In intubated patients, the maximum
GCS score is 10T and the minimum score is 2T

19. GCS-P
• In 2018, a team of experts — including one of the original creators of
the GCS — published an updated version of the GCS called the “GCS-
P.” The P stands for “pupil,”
• Pupil reaction is important because it’s an indicator of your brain
function. When your pupils don’t react to light, it’s a sign that a
serious problem or injury is affecting your brain. The pupil score
ranges from 0 to 2.

20. The pupil scores mean:
• 2: Neither pupil reacts to light.
• 1: One pupil doesn’t react to light.
• 0: Both pupils react to light.

21. • The GCS-P is calculated by subtracting the Pupil
Reactivity Score (PRS) from the Glasgow Coma
Scale (GCS) total score:
GCS-P = GCS - PRS
• Example:
A GCS score of 3 and a pupil score of 2
GCS-P score of 1

22. GCS RANGES FOR HEAD INJURIES
The GCS in connection with a head injury, they tend to apply
scoring ranges to describe how severe the injury is. The ranges are:
• 13 to 15: Mild traumatic brain injury (mTBI). Also known as a
concussion.
• 9 to 12: Moderate TBI.
• 3 to 8: Severe TBI.

23. SIMPLE CLASSIFICATION
ACCORDING TO GCS SCORE
•less than 8 : unconscious
•9 to 12 : semiconscious
•13 to 15 : conscious

24. A NOTE FROM CLEVELAND CLINIC
• The Glasgow Coma Scale is the most common tool healthcare
providers use to measure decreases in consciousness and
comas. Since its creation almost 50 years ago, experts have
studied the scale extensively and found that it continues to be a
useful diagnostic tool. (They’ve even improved it along the way.)
Using this tool also helps providers track changes in brain
function. That helps guide treatment and improve care for
people with conditions that affect their level of consciousness.