1. Management of Unconscious patient Prepared by- Dr. Abdul Mottalib Sarker

14. Glasgow Coma scale The scale comprises three tests: eye , verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death ), while the highest is 15 (fully awake person). Obeys command Localizes painful stimuli Flexion / Withdrawal to painful stimuli Abnormal flexion to painful stimuli Extension to painful stimuli Makes no movements Motor N/A Oriented, converses normally Confused, disoriented Utters inappropriate words Incomprehensible sounds Makes no sounds Verbal N/A N/A Opens eyes spontaneously Opens eyes in response to voice Opens eyes in response to painful stimuli Does not open eyes EYE 6 5 4 3 2 1

26. Pupil Both pupils are dilated and unreactive to light. This could be due to overdose of certain medications, hypothermia or severe anoxia (lack of oxygen). • ʖ • One pupil is dilated and unreactive, while the other is normal (in this case the L eye is dilated but the R eye is normal in size). This could mean a damage to the oculomotor nerve (cranial nerve number 3, CN III) on the right side, or possibility of vascular involvement. • ʖ• "Pinpoint" pupils indicate heroin or opiate overdose, and can be responsible for a patient's coma. The pinpoint pupils are still reactive to light, bilaterally (in both eyes, not just one). Another possibility is the damage of the pons. • ʖ • Normal eye with two pupils equal in size and reactive to light. This means that the patient is probably not in a coma and is probably lethargic, under influence of a drug, or sleeping. • ʖ • Possible interpretation Pupil sizes (Left eye vs. Right eye)

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