4.Glasgow coma scale for stroke patient.pptx

Education

1. By Dr.Sayeed uddin Helal MS( Neurosurgery), ZZU. Glasgow Coma Scale (GCS)

2. Glasgow scoring Category Response Points E ye opening Spontaneous, open with blinking at baseline 4 Opens to verbal command, speech, or shout 3 Opens to pain, not applied to face 2 No response 1 V erbal response Oriented conversation 5 Disoriented, confused conversation, able to answer questions 4 Inappropriate responses, words discernible 3 Incomprehensible speech 2 No response 1 Intubated 1T M otor response Obeys commands for movement 6 Purposeful movement to painful stimulus 5 Withdraws from pain 4 Abnormal (spastic) flexion, decorticate posture 3 Extensor (rigid) response, decerebrate posture 2 No response 1

3. 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

4. Prognosis variability Past medical history Age, previous neurological problems Injury Type and location, depth, duration of coma, presence of low blood pressure, oxygen levels after the injury Current findings Physical examinations, radiological studies of the brain

5. Clinical Scenario A 20 year old white male presented to the EC unconscious 5 minutes after missing the pole vault pit and landing with the occipital region of his head hitting the ground. Neurologic evaluation on admission as follows: patient’s eyes opened to the sound of his name, and when asked where he was, the patient responded with “my shoes to change.” The patient moved all of his fingers and toes when prompted. What is this patient’s score on the Glasgow Coma Scale ?

6. Clinical Scenario (revisited ) The patient’s eyes initially closed, opened to the sound of his name. Eye opening 3 When asked where he was, the patient said “my shoes to change.” Verbal response 3 The patient moved all of his fingers and toes when prompted. Motor response 6

7. Case Scenario SCORE GCS 12 = E3 V3 M6 at 16:34 Head injury severity Moderate

8. AVPU A = Alert V= Response to vocal stimuli P= Responds to pain U= unresponsiveness