Glasgow Coma Scale Overview

Overview

This lecture explains the Glasgow Coma Scale (GCS), a tool used to assess a patient's level of consciousness, especially after brain injury, covering its scoring system and practical application.

Purpose of the Glasgow Coma Scale

• The GCS measures how alert and responsive a patient is to stimuli.
• It is commonly used for patients with traumatic brain injuries or conditions affecting brain function.
• The scale helps monitor changes in consciousness over time for clinical assessment.

GCS Scoring System

• The GCS assesses three responses: Eye opening, Verbal, and Motor (EVM).
• Each category has its own score: Eye (max 4), Verbal (max 5), Motor (max 6).
• Scores range from 3 (deep coma) to 15 (fully alert); 3–8 = severe injury, 9–12 = moderate, 13–15 = mild.
• Subscores for each category are important when reporting GCS.
• Use “NT” (Not Testable) if a category cannot be assessed due to injury or intervention.

Methods for Stimulating Response

• Stimuli may be verbal (speaking), central pain (trapezius squeeze, supraorbital pressure), or peripheral pain (fingernail bed pressure).
• Central stimuli test brain response; peripheral stimuli test spinal cord response.
• Avoid certain pain stimuli (e.g., sternal rub) if injury is present or contraindicated.

Eye Opening Response (E)

• 4 points: Opens eyes spontaneously.
• 3 points: Opens eyes to verbal stimuli.
• 2 points: Opens eyes to pain.
• 1 point: No response.
• NT: Eyes swollen shut or injury preventing assessment.

Verbal Response (V)

• 5 points: Oriented (correctly identifies self, date, place).
• 4 points: Confused conversation.
• 3 points: Inappropriate words.
• 2 points: Incomprehensible sounds.
• 1 point: No response.
• NT: Intubated or unable to assess verbally.

Motor Response (M)

• 6 points: Follows two-step motor commands.
• 5 points: Localizes pain (moves limb toward stimulus).
• 4 points: Withdraws from pain (normal flexion).
• 3 points: Abnormal flexion (decorticate posturing).
• 2 points: Extension (decerebrate posturing).
• 1 point: No response.
• NT: Paralyzed, sedated, or otherwise untestable.

Reporting and Interpretation

• Always consider pre-existing conditions that may limit response in any GCS category.
• If not testable, report with NT and use qualifiers (e.g., "GCS 6T" for intubated).
• Subscores provide more detail than total score alone.

Example Calculation

• Eye opening to pain (2), verbal response with sounds only (2), localizes pain (5), total GCS = 9.

Key Terms & Definitions

• Glasgow Coma Scale (GCS) — Numeric tool for assessing consciousness through eye, verbal, and motor responses.
• Central Stimulus — Pain applied to core areas (e.g., trapezius squeeze) to test brain’s response.
• Peripheral Stimulus — Pain applied to extremities (e.g., fingernail bed) to test spinal response.
• Decorticate Posturing — Abnormal flexion toward the body core, indicates cortical damage.
• Decerebrate Posturing — Extension of limbs, indicates brainstem injury.
• Not Testable (NT) — Used when a response cannot be assessed due to injury, intubation, or other reasons.

Action Items / Next Steps

• Take the free quiz linked in the video description to test your understanding of the Glasgow Coma Scale.