Gcs( GLASGOW COMA SCALE)

The Glasgow Coma Scale (GCS) is a neurological scale which aims to give a reliable and objective way of recording the conscious state of a person for initial as well as subsequent assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (more widely used modified or revised scale).

1. GLASGOW COMA SCALE PRESENTED BY PANKAJ SINGH RANA NURSE PRACTITIONER IN CRITICAL CARE

2. OBJECTIVE INTRODUCTION DEFINITION EYE SCORE VEERBAL SCORE MOTOR SCORE INTERPREATION SUMMARY

3. INTRODUCTION The scale was published in 1974 by Graham Teasdale and Bryan J. Jennett , professors of neurosurgery at the University of Glasgow's Institute of Neurological Sciences at the city's Southern General Hospital. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) to 15 ( full consciousness).

4. DEFINITION The  Glasgow coma scale  ( GCS ) is a neurological scale which aims to give a reliable way of recording the conscious state of a person.

5. SCALE SCORING GCS check 3 components Eye Response (1-4) Verbal Response (1-5) Motor Response (1-6)

6. EYE RESPONSE (E) There are four grades starting with the most severe: No eye opening Eye opening in response to pain stimulus. (a peripheral pain stimulus, such as squeezing the  lunula  area of the patient's fingernails more effective than a central stimulus such as a trapezius squeeze, due to a grimacing effect). Eye opening to speech. (Not to be confused with the awakening of a sleeping person; such patients receive a score of 4, not 3.) Eyes opening spontaneously

7. VERBAL RESPONSE (V) There are five grades starting with the most severe: No verbal response Incomprehensible sounds. (Moaning but no words.) Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange. Speaks words but no sentences.) Confused. (The patient responds to questions coherently but there is some disorientation and confusion.) Oriented. (Patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month, etc.)

8. MOTOR RESPONSE (M) No motor response Decerebrate posturing  accentuated by pain (extensor response: adduction of arm, internal rotation of shoulder,  pronation  of forearm and extension at elbow, flexion of wrist and fingers, leg extension, plantar flexion of foot) Decorticate posturing accentuated by pain (flexor response: internal rotation of shoulder, flexion of forearm and wrist with clenched fist, leg extension, plantar flexion of foot)

9. 4. Withdrawal from pain (absence of abnormal posturing; unable to lift hand past chin with supra orbital pain but does pull away when nail bed is pinched) 5. Localizes to pain (purposeful movements towards painful stimuli; e.g., brings hand up beyond chin when supra orbital pressure applied) 6. Obeys commands (the patient does simple things as asked)

10. INTERPRETATION Generally, brain injury is classified as: Severe, GCS < 8–9 Moderate, GCS 8 or 9–12 (controversial) Minor, GCS ≥ 13.

11. A- ALERT (15) V- RESPOND TO VERBAL STIMULUS (13) P- RESPOND TO STIMULI (5) U- UN RESPONSIVE (3)

12. LIMITATION Tracheal intubation and severe facial/eye swelling or damage make it impossible to test the verbal and eye responses. In these circumstances, the score is given as 1 with a modifier attached (e.g. "E1c", where "c" = closed, or "V1t" where t = tube). Often the 1 is left out, so the scale reads Ec or Vt. The GCS has limited applicability to children, especially below the age of 36 months (where the verbal performance of even a healthy child would be expected to be poor).