Welcome to Naija Nurses Forum

Register now to gain access to all of our features. Once registered and logged in, you will be able to contribute to this site by submitting your own content or replying to existing content. You'll be able to customize your profile, receive reputation points as a reward for submitting content.

Using Glasgow Coma Scale (GCS)

Tell us about your experience in nursing. What is your specialty and where are you from?
Let's get to know each other
Justnurse
Reactions:
Posts: 4
Joined: Sat Nov 17, 2012 3:04 pm

Using Glasgow Coma Scale (GCS)

Unread post by Justnurse » Thu Feb 28, 2013 2:23 pm

The Glasgow Coma Scale, or GCS, is a tool nurses use to assess a patient's level of consciousness. The scale rates three areas, eye opening, verbal response and motor response. It is taught in nursing school as a basic physical assessment tool. The possible range of scores is 3-15. The higher the number, the more alert the patient. Lower numbers indicate coma.

Glasgow Coma Scale (GCS) is the most common scoring system used to describe the level of consciousness in a person following a traumatic brain injury. Basically, it is used to help gauge the severity of an acute brain injury. The test is simple, reliable, and correlates well with outcome following severe brain injury.

The GCS is a reliable and objective way of recording the initial and subsequent level of consciousness in a person after a brain injury. It is used by trained staff at the site of an injury like a car crash or sports injury, for example, and in the emergency department and intensive care units.

The GCS measures the following functions:

Eye Opening (E)
  • •4 = spontaneous
    •3 = to voice
    •2 = to pain
    •1 = none
Verbal Response (V)
  • •5 = normal conversation
    •4 = disoriented conversation
    •3 = words, but not coherent
    •2 = no words, only sounds
    •1 = none
Motor Response (M)
  • •6 = normal
    •5 = localized to pain
    •4 = withdraws to pain
    •3 = decorticate posture (an abnormal posture that can include rigidity, clenched fists, legs held straight out, and arms bent inward toward the body with the wrists and fingers bend and held on the chest)
    •2 = decerebrate (an abnormal posture that can include rigidity, arms and legs held straight out, toes pointed downward, head and neck arched backwards)
    •1 = none
[/color]
Clinicians use this scale to rate the best eye opening response, the best verbal response, and the best motor response an individual makes. The final GCS score or grade is the sum of these numbers.

Using the Glasgow Coma Scale

Every brain injury is different, but generally, brain injury is classified as:
  • •Severe: GCS 3-8 (You cannot score lower than a 3.)
    •Moderate: GCS 9-12
    •Mild: GCS 13-15
Mild brain injuries can result in temporary or permanent neurological symptoms and a neuro-imaging tests such as CT scan or MRI may or may not show evidence of any damage.

Moderate and severe brain injuries often result in long-term impairments in cognition (thinking skills), physical skills, and/or emotional/behavioral functioning.

Limitations of the Glasgow Coma Scale

Factors like drug use, alcohol intoxication, shock, or low blood oxygen can alter a patient’s level of consciousness. These factors could lead to an inaccurate score on the GCS.

Children and the Glasgow Coma Scale

The GCS is usually not used with younger children, especially those too young to have reliable language skills. The Pediatric Glasgow Coma Scale, or PGCS, a modification of the scale used on adults, is used instead. The PGCS still uses the three tests — eye, verbal, and motor responses — and the three values are considered separately as well as together.

Here is the slightly altered grading scale for the PGCS:

Eye Opening (E)
•4 = spontaneous
•3 = to voice
•2 = to pain
•1 = none

Verbal Response (V)
•5 = smiles, oriented to sounds, follows objects, interacts
•4 = cries but consolable, inappropriate interactions
•3 = inconsistently inconsolable, moaning
•2 = inconsolable, agitated
•1 = none

Motor Response (M)
•6 = moves spontaneously or purposefully
•5 = withdraws from touch
•4 = withdraws to pain
•3 = decorticate posture (an abnormal posture that can include rigidity, clenched fists, legs held straight out, and arms bent inward toward the body with the wrists and fingers bend and held on the chest)
•2 = decerebrate (an abnormal posture that can include rigidity, arms and legs held straight out, toes pointed downward, head and neck arched backwards)
•1 = none

Pediatric brain injuries are classified by severity using the same scoring levels as adults, i.e. 3-8 reflecting the most severe, 9-12 being a moderate injury and 13-15 indicating a mild TBI. As in adults, moderate and severe injuries often result in significant long-term impairments.



References
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974,2:81-84. PMID 4136544.



Justnurse
Reactions:
Posts: 4
Joined: Sat Nov 17, 2012 3:04 pm

Re: Using Glasgow Coma Scale (GCS)

Unread post by Justnurse » Thu Feb 28, 2013 2:35 pm

How to Perform the Glasgow Coma Scale

1. Assess the patient's eye opening. A total of 4 points may be given for eye opening. A patient who opens their eyes spontaneously, such as an alert patient sitting in a chair, would be scored a 4. If the patient is asleep or lying with eyes closed, but opens them upon command, a 3 is awarded. If the patient only opens their eyes to painful stimulus, such as running the tip of blunt scissors along the bottom of the foot, or a pinch, the patient is scored a 2. A patient who does not open their eyes no matter what is given a 1. Some patients may rouse if a very bright penlight is held a few inches from their eyes in order to induce a response.

2. Ask the patient questions, or engage in routine conversation to assess verbal response. A patient who engages in normal, appropriate conversation would be given a 5 on the GCS. A patient who makes appropriate conversation but is confused, such as an Alzheimer's patient, would be scored as a 4. The patient who makes inappropriate conversation, such as answering a question on an entirely different subject, would be given a 3. If the patient cannot make conversation, but instead has very garbled speech or makes incomprehensible sounds,they would be given a 2. The patient who is unable to speak or make any sounds for any reason, such as being on a ventilator with a breathing tube in their mouth, would be given a 1.

3. If the patient is lying still, ask him to wiggle his feet or raise his left arm and assess the response. A patient who moves arms and legs either spontaneously or on command is given a 6. If the patient displays purposeful movement with a painful or unpleasant stimulus, such as trying to push it away, the patient is given a 5. The patient who only withdraws away from pain with no other response is given a 4. A score of 3 is given to the patient demonstrating decorticate posturing, in which the patient's extremities are drawn inward toward the center of the body. If the patient is in the decerebrate posture, the extremities are turned away from the body, and the score is 2. The lack of any movement or posturing is given a 1.

4. Record the GCS findings in the patient's chart. Assess with routine physical assessment, or whenever a change in GCS is noted. Report findings to physician as indicated.
Image

Justnurse
Reactions:
Posts: 4
Joined: Sat Nov 17, 2012 3:04 pm

Re: Using Glasgow Coma Scale (GCS)

Unread post by Justnurse » Thu Feb 28, 2013 2:46 pm

42-year-old gentleman was an unbelted passenger in a motor vehicle accident. On arrival to the hospital, the paramedics inform you that he opens his eyes in response to verbal stimuli. He is incoherent and withdraws from painful stimuli.

Which of the following is the patient’s calculated Glasgow Coma Scale (GCS)?
a. 15
b. 3
c. 9
d. 5
e. 12
Image

Mark Spencer
Reactions:
Posts: 6
Joined: Mon Apr 08, 2013 10:29 am

Re: Using Glasgow Coma Scale (GCS)

Unread post by Mark Spencer » Tue Apr 09, 2013 11:29 am

I read quality feature article about Glasgow Coma Scale (GCS), Its good and looks attractive to use for perfect weighting and measurements. Its really useful and informative for me. to compare scales performances.

User avatar
Kunle Emmanuel
Webmaster
Webmaster
Reactions:
Posts: 1892
Joined: Mon Jan 09, 2012 5:02 pm
Location: Lagos
Contact:

Re: Using Glasgow Coma Scale (GCS)

Unread post by Kunle Emmanuel » Tue Feb 17, 2015 6:54 pm

1. What is GCS. (Glasgow Coma Scale).
2. Which category of patients is it used for?
3. State the various scores or classification.
4. At what score will a patient require critical care?
Answer any or all Just to refresh our knowledge.

Olufemi Iseyemi Folakemi
Glasgow coma scale is a scale used to asses the level of consciousness of critically ill patients based on their level of performance/ awareness.....GCS should be used to asses all patients, most specifically critically ill with possibility of CNS deterioration. eg head injured patients, patient recovering from effect of anaesthesia, patient on clinical sedation/medically induced anaesthesia, pre/post op neurosurgical patients etc..........

Determining a GCS is based on three fundamental functioning level, which are dependent on intact CNS and optimal awareness......they include:
  • (a) effective eye opening
    (b) effective verbal response and
    (c) effective motor response.
Each are rated based on the sensitivity of CNS functioning required to perform them
(a) is giving a rating of 4,
(b) is giving a rating of 5 and
(c) is giving a rating of 6.........

Summing all together produce a total value of 15 which is normal for fully conscious, alert and well oriented individual. Critically ill patients tends to have GCS less than 9, at such point supportive therapy like intubation etc becomes imperative.

Adewunmi Joshua
Nigerian Nurses lighting up the world one candle at a time.

Alexa1994
Reactions:
Posts: 20
Joined: Tue Jun 20, 2017 2:06 pm

Re: Using Glasgow Coma Scale (GCS)

Unread post by Alexa1994 » Wed Jun 21, 2017 7:05 am

Adewunmi Joshua Thanks for providing the answers dear :)

Post Reply Previous topicNext topic

Social Media

       

Who is online

Users browsing this forum: No registered users and 1 guest