Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Glasgow Coma Scale 
Emergency In-Service Lecture
GLASGOW COMA SCALE 
Graham M. Teasdale was Professor and Head of the 
Department of Neurosurgery, 
University of Glasgow (...
GLASGOW COMA SCALE 
The Glasgow Coma Scale (GCS) was developed to 
assess the level of neurologic injury, and includes 
as...
GLASGOW COMA SCALE 
The Glasgow Coma Scale has proved a practical and 
consistent means of monitoring the state of head in...
GCS: EYE OPENING 
Useful as a reflection of the intensity of impairment of 
activating functions 
Spontaneous eye opening ...
GCS: EYE OPENING 
Eye opening in response to 
speech 
•It is sought by speaking or shouting at the 
patient. 
•Any suffici...
GCS: EYE OPENING 
Eye opening response to 
pain 
•It is assessed if the person is not opening their eyes to 
sound. 
•It i...
GCS: EYE OPENING 
An absence of eye 
opening 
•It implies substantial impairment of brain stem arousal 
mechanisms. 
•Subs...
GCS: VERBAL RESPONSE 
Orientation 
•It is the highest level of response and 
implies awareness of self and 
environment. 
...
GCS: VERBAL RESPONSE 
Confused Conversation 
•It is recorded if the patient engages in 
conversation but is unable to prov...
GCS: VERBAL RESPONSE 
Inappropriate Speech 
•It is assigned if the person produces only one 
or two words, in an exclamato...
GCS: VERBAL RESPONSE 
Incomprehensible 
Sounds 
•It is consist of moaning and groaning but 
without any recognizable words...
GCS: VERBAL RESPONSE 
No Verbal Response 
•No verbal response upon pain stimulus. 
•Substantial effort should be made earl...
GCS: MOTOR RESPONSES 
The assessment of motor responsiveness becomes important in a 
person not 
conversing to at least a ...
GCS: MOTOR RESPONSES 
Localizatio 
n 
•It is done with the application of pressure 
on the supraorbital notch 
•Localizing...
GCS: MOTOR RESPONSES 
A Withdrawal Response 
•It is recorded if the elbow bends away 
from pain stimulus but the movement ...
GCS: MOTOR RESPONSES 
An Abnormal Flexion Response 
(Decorticate) 
•It is recorded if the elbow bends in decorticate 
post...
GCS: MOTOR RESPONSES 
An Extension Response 
(Decerebrate) 
•It is recorded if the elbow only straightens 
and the movemen...
GCS: MOTOR RESPONSES 
Absence of Motor Response. 
•It is recorded if no limb movement upon 
pain stimulus
GCS: MOTOR RESPONSES 
What kind of flexion movements can be recognized? 
normal flexion movement 
•It is characterized by ...
GCS: MOTOR RESPONSES 
Why is it the best motor response? 
•The scale is based upon taking account of the best 
response of...
GCS: MOTOR RESPONSES 
What needs to be checked if there is apparently no response? 
•An absence of motor response clearly ...
GCS: CONSISTENCY 
Inter-observer consistency has been examined by 
many investigators and has been shown to be robust in 
...
GCS: HOW SOON ? 
In the acute stage, the sooner an observation is made, 
the more useful it is as a guide to predict the u...
GCS: HOW OFTEN ? 
•The shorter the time between an injury or other event 
and the assessment, the more the security about ...
GCS: HOW MUCH CHANGE MATTER ? 
•Questions are asked about the extent of change that should 
take place in order to trigger...
GCS: RELATIONSHIP BETWEEN 
THE SCALE AND THE SCORE? 
The total or sum score (coma score) was initially used 
as a way of s...
GCS: RELATIONSHIP BETWEEN 
THE SCALE AND THE SCORE? 
A major limitation of the total score is the difficulty to 
translate...
GCS: IS THE TOTAL SCORE 14 
OR 15? 
It is a result of the differences in the approaches to 
assessment of flexion motor re...
CHILDREN COMA SCALE 
The Glasgow Coma Scale (GCS) as an objective 
assessment of neurological function, is of Limited 
use...
PAEDIATRIC COMA SCALE 
Simpson and Reilly (1982)
CHILD’S GLASGOW COMA SCALE 
British Pediatric Neurology Association
CONCLUSIONS 
Although initially described four decades ago, the 
Glasgow approaches to assessment of initial severity 
and...
GLASGOW SCORE 
Score Range 
Extubated: 3 – 15 
Intubated: 3 – 11T 
Clinical Presentation 
Normal: GCS =15 
Comatose: G...
Glasgow Coma Scale Presentation
Glasgow Coma Scale Presentation
Upcoming SlideShare
Loading in …5
×

Glasgow Coma Scale Presentation

40,370 views

Published on

Detailed discussion on Glasgow Coma Scale

Published in: Healthcare

Glasgow Coma Scale Presentation

  1. 1. Glasgow Coma Scale Emergency In-Service Lecture
  2. 2. GLASGOW COMA SCALE Graham M. Teasdale was Professor and Head of the Department of Neurosurgery, University of Glasgow (1981 to 2003). What were the main factors in the design of the scale? The approach should be simple and practicable, useable in a wide range of hospitals by staff without special training.
  3. 3. GLASGOW COMA SCALE The Glasgow Coma Scale (GCS) was developed to assess the level of neurologic injury, and includes assessments of movement, speech, and eye opening This avoids the need to make arbitrary distinctions between consciousness and different levels of coma Brain injury is often classified as Severe (GCS ≤ 8), Moderate (GCS 9–12), Mild (GCS ≥ 13) Quick neurologic assessment for •Prognosis •Victim’s ability to maintain patent airway on own
  4. 4. GLASGOW COMA SCALE The Glasgow Coma Scale has proved a practical and consistent means of monitoring the state of head injured patients. In the acute stage, changes in conscious level provide the best indication of the development of complications such as intracranial haematoma whilst the depth of coma and its duration indicate the degree of ultimate recovery which can be expected. GCS does not entail assumptions of specific underlying anatomical lesions or physiological mechanisms
  5. 5. GCS: EYE OPENING Useful as a reflection of the intensity of impairment of activating functions Spontaneous eye opening •It indicates arousal mechanisms brain stems are active •It does not imply awareness.
  6. 6. GCS: EYE OPENING Eye opening in response to speech •It is sought by speaking or shouting at the patient. •Any sufficiently loud sound can be used, not necessarily a command to open the eyes.
  7. 7. GCS: EYE OPENING Eye opening response to pain •It is assessed if the person is not opening their eyes to sound. •It is should not causes unnecessary injury to the patient. •The stimulus should be pressure on the bed of a fingernail or supraorbital nerve.
  8. 8. GCS: EYE OPENING An absence of eye opening •It implies substantial impairment of brain stem arousal mechanisms. •Substantial effort should be made earlier to ensure that this is not due to an inadequate stimulation.
  9. 9. GCS: VERBAL RESPONSE Orientation •It is the highest level of response and implies awareness of self and environment. •The person should be able to provide answers to at least three questions, 1. who they are 2. where they are 3. the date – at least in terms of the year the month and day of the week.
  10. 10. GCS: VERBAL RESPONSE Confused Conversation •It is recorded if the patient engages in conversation but is unable to provide any of the foregoing three points of information. •The key factor is that the person can produce appropriate phrases or sentences.
  11. 11. GCS: VERBAL RESPONSE Inappropriate Speech •It is assigned if the person produces only one or two words, in an exclamatory way, often swearing. •It is commonly produced by stimulation and does not result in sustained conversation exchange.
  12. 12. GCS: VERBAL RESPONSE Incomprehensible Sounds •It is consist of moaning and groaning but without any recognizable words. •It is commonly produced by stimulation and does not result in sustained conversation exchange.
  13. 13. GCS: VERBAL RESPONSE No Verbal Response •No verbal response upon pain stimulus. •Substantial effort should be made earlier to ensure that this is not due to an inadequate stimulation.
  14. 14. GCS: MOTOR RESPONSES The assessment of motor responsiveness becomes important in a person not conversing to at least a confused level Obeying Commands •It is the best response possible. •Confirmation of the specificity of the response by squeezing and releasing the fingers or holding up the arms or other movement elicited by verbal command.
  15. 15. GCS: MOTOR RESPONSES Localizatio n •It is done with the application of pressure on the supraorbital notch •Localizing should be recorded only if the person’s hand reaches above the clavicle in an attempt to remove the stimulus. •If in doubt, stimulation can be applied to more than one site to ensure that the hand attempts to remove it
  16. 16. GCS: MOTOR RESPONSES A Withdrawal Response •It is recorded if the elbow bends away from pain stimulus but the movement is not sufficient to achieve localization
  17. 17. GCS: MOTOR RESPONSES An Abnormal Flexion Response (Decorticate) •It is recorded if the elbow bends in decorticate posturing and the movement is not sufficient to achieve localization
  18. 18. GCS: MOTOR RESPONSES An Extension Response (Decerebrate) •It is recorded if the elbow only straightens and the movement should not sufficient to achieve localization.
  19. 19. GCS: MOTOR RESPONSES Absence of Motor Response. •It is recorded if no limb movement upon pain stimulus
  20. 20. GCS: MOTOR RESPONSES What kind of flexion movements can be recognized? normal flexion movement •It is characterized by rapid withdrawal, abduction of the shoulder, and external rotation which varies from stimulation to stimulation abnormal flexion movement The distinction is useful prognostically •It is clearly present when the response is slow, stereotyped – that is repeated time after time – and results in the arm moving to an adducted internally rotated position, characteristic of the hemiplegic or so called decorticate posture
  21. 21. GCS: MOTOR RESPONSES Why is it the best motor response? •The scale is based upon taking account of the best response of the better limb. •The highest level of response achieved provides the most consistent assessment of the patient’s state and the best guide to the integrity of brain function remaining.
  22. 22. GCS: MOTOR RESPONSES What needs to be checked if there is apparently no response? •An absence of motor response clearly equates to a severe depression of function. •Before ascribing this to structural damage it is important to exclude other causes – for example the effects of systemic insults such as hypoxia, hypotension or the use of drugs. •Comparison should be made of the responses in the legs and arms with those in head and neck injury in order to alert the examiner to the possibility of spinal cord or brain stem injury. •It is also important to ensure a stimulus of adequate intensity has been applied.
  23. 23. GCS: CONSISTENCY Inter-observer consistency has been examined by many investigators and has been shown to be robust in a wide, relevant range of circumstances including emergency departments, intensive care units and in pre-hospital care.
  24. 24. GCS: HOW SOON ? In the acute stage, the sooner an observation is made, the more useful it is as a guide to predict the ultimate outcome. In the acute state where patient’s state of consciousness is influenced by remedial disorders – for example hypoxia or hypotension, prognosis have been based upon an assessment after sufficient time has passed. Post resuscitation GCS usually assess after 6 hours, in a well resuscitated patient.
  25. 25. GCS: HOW OFTEN ? •The shorter the time between an injury or other event and the assessment, the more the security about the stability of a patient’s condition. •Observations at frequent intervals are appropriate for example every few minutes and at least several times within an hour. •As time passes the frequency can be reduced, and related to whether or not there are reasons for considering the patient needs continuing observation and care.
  26. 26. GCS: HOW MUCH CHANGE MATTER ? •Questions are asked about the extent of change that should take place in order to trigger action. •It may determine transfer to another unit e.g. from a general to a specialist neurosurgical department. •Again, hard and fast rules are not appropriate. The general guidance is that it depends upon where the patient is showing change from and the extent of the change •Generally significant changes when total score reduces by 2 points or motor response reduces by single point
  27. 27. GCS: RELATIONSHIP BETWEEN THE SCALE AND THE SCORE? The total or sum score (coma score) was initially used as a way of summarizing information, in order to make it easier to present group data. However, the resulting score proved a useful and powerful summary of the extent of brain dysfunction and showed a strong relationship with prognosis When describing an individual patient, especially when communicating with colleagues, it is always preferable to refer to the responses observed and not to rely upon communication through the intermediary of numbers or a total score.
  28. 28. GCS: RELATIONSHIP BETWEEN THE SCALE AND THE SCORE? A major limitation of the total score is the difficulty to translate the score into a clear picture of the patient’s actual condition. This is particularly a risk in telephone exchanges.
  29. 29. GCS: IS THE TOTAL SCORE 14 OR 15? It is a result of the differences in the approaches to assessment of flexion motor responses In the simpler system, recommended for routine use in patient monitoring, no attempt is made to distinguish between normal and abnormal flexion. This results in a system summing to a total of 14 Distinction between normal and abnormal flexion important in assessing the significant deterioration from normal to abnormal brain responses – Important prognostic factor
  30. 30. CHILDREN COMA SCALE The Glasgow Coma Scale (GCS) as an objective assessment of neurological function, is of Limited usefulness in children under 3 years of age One of the components of the Glasgow coma scale is the best verbal response which cannot be assessed in nonverbal small children A modification of the original Glasgow coma scale was created for children too young to talk
  31. 31. PAEDIATRIC COMA SCALE Simpson and Reilly (1982)
  32. 32. CHILD’S GLASGOW COMA SCALE British Pediatric Neurology Association
  33. 33. CONCLUSIONS Although initially described four decades ago, the Glasgow approaches to assessment of initial severity and outcome of brain damage have weathered the test of time. It remains the standard for acute assessment Alternatives to and adaptations of the Glasgow Scales have been described. Some of these have clear advantages, for example in relation to children.
  34. 34. GLASGOW SCORE Score Range Extubated: 3 – 15 Intubated: 3 – 11T Clinical Presentation Normal: GCS =15 Comatose: GCS ≤ 8 Dead: GCS = 3 Grading Of Head Injury Minor: GCS ≥13 Moderate: GCS 9 -12 Severe: GCS ≤ 8 Example report GCS 9 = E2 V4 M3 at 07:35

×