Glasgow Coma Scallllllllllllllllle2.pptx

Glasgow Coma Scallllllllllllllllle2

1. Glasgow Coma Scale (GCS) A Neurosurgery unit seminar presentation by Olasupo Aisha, Kiyoh Elian and Olumuyiwa Breakthrough.

2. Outline Definition History and Development Components of GCs Eye Opening Response Verbal Response Motor Response Scoring and interpretation Limitations

3. Definition The Glasgow Coma Scale (GCS) is a neurological scoring system used to objectively measure a patient’s level of consciousness (LOC) after a head injury or any condition affecting the brain.

4. Definition It assesses how awake, responsive, and aware a person is by observing three key functions: Eye opening (E) Verbal response (V) Motor response (M)

5. Purpose

6. History and Development

7. History and Development

8. Components of GCS The Glasgow Coma Scale (GCS) assesses a patient’s level of consciousness through three key responses: A. Eye Opening Response (E) – 4 points What It Tests: Brainstem function and arousal mechanism of the reticular activating system. SCORE RESPONSE CLINICAL MEANING 4 Opens eyes spontaneously Fully awake and alert 3 Opens eyes to speech Responds when spoken to 2 Opens eyes to pain Responds only to painful stimulus 1 No eye opening Deep coma/ brain dysfunction

9. Eye Opening Response

10. Components of GCS B. Verbal Response (V) – 5 points What It Tests: Cortical function — how well the patient can speak, orient, and comprehend. How to Test : Ask simple orientation questions:“What’s your name?” “Where are you?” “What month or year is it?” Note the highest level of coherent speech. SCORE RESPONSE CLINICAL MEANING 5 Oriented Fully coherent 4 Confused conversation Answers questions but disoriented 3 Inappropriate words Random words, not conversational 2 Incomprehensible sounds Moaning, groaning only 1 No verbal response Silent/ intubated/ coma

11. Verbal Response (V) Example: If patient says, “I’m at home” (while in hospital), score V4. For Infants/Non-verbal children: Use Modified Pediatric GCS— e.g., coos and babbles (V5), cries to pain (V2), etc.

12. Motor Response (M) C. Motor Response (M) – 6 points What It Tests: Integrity of corticospinal tracts and ability to respond purposefully. SCORE RESPONSE CLINICAL IMPLICATION 6 Obeys command Purposeful movement 5 Localized pain Moves hand towards site of pain 4 Withdraws from pain Pulls limb away 3 Flexion ( decorticate posture) Abnormal Flexion to pain 2 Extension (reverberate posture) Abnormal Extension to pain. 1 No movement

13. Motor Response (M) How to Test: Give a simple command: “Lift your hand,” “Squeeze my finger.” If no response, apply pain stimulus: . Central: trapezius pinch or supraorbital pressure. Peripheral: nail bed pressure. Observe if patient localizes, withdraws, or shows abnormal posturing.

14. Scoring and Interpretation How the Scoring Works* Each component of the GCS contributes a specific number of points: Total GCS = E + V + M = 3–15 Where 15 = fully conscious 3 = deepest coma or death Component Maximum score Minimum score Eye opening (E) 4 1 Verbal Response (V) 5 1 Motor Response (M) 6 1

15. Interpreting the Total GCS Because a GCS of 8 or less indicates inability to protect the airway, and likely loss of gag and cough reflexes.   Trend is More Important Than One Score   Don’t just write a single GCS score. Always compare with previous scores to see if the patient is improving or worsening. Total score Level of Consciousness Severity Clinical Implications 13-15 Usually conscious Mild reassess 9-12 Usually unconscious Moderate Risk of deterioration; admit, monitor ICP ≤8 Usually unconscious Severe Airway threatened → Intubate & ICU

16. Special Cases

17. LIMITATIONS & CONCLUSION Influenced by External Factors : Sedation, alcohol, drugs, or paralysis can falsely lower scores. Intubated or Tracheostomized Patients: Verbal response can’t be tested → must document as “V (T) or not assessable. Facial or Eye Injuries : Swelling or trauma can affect eye-opening assessment. Language & Hearing Barriers: Misinterpretation of commands affects verbal and motor scoring. Children & Neonates: Standard GCS not suitable; requires Modified Pediatric GCS for accurate evaluation. Does Not Assess All Neurological Functions: Ignores pupil reaction, brainstem reflexes, and vital signs — so it must be used with full neuro exam.

18. Thanks for listening