Assess Level of Consciousness (LOC): Determines how alert/responsive a patient is to their environment.
Evaluation of Brain Function: Helpful in evaluating patients with traumatic brain injuries or other conditions affecting brain function and consciousness.
Score Calculation: Provides a specific score (e.g., GCS of 7 or 10) indicating the patient's LOC.
Importance of Baseline and Regular Reassessment
Baseline Score: Obtain an initial score to track changes over time.
Monitor Changes: Regular reassessment to determine if a patient’s condition is improving, stable, or deteriorating.
Components of GCS
Eye Opening Response (E)
Verbal Response (V)
Motor Response (M)
Stimuli for Testing Responses
Types of Stimuli:
Verbal Stimuli: Simple communication.
Pressure/Painful Stimuli:
Central Stimuli: Pressure applied to the body’s core.
Peripheral Stimuli: Pressure applied to extremities (e.g., fingernail bed).
Pressure Techniques
Central Stimuli:
Trapezius Squeeze: Use fingers to apply pressure to the trapezius muscle; increase intensity over 10 seconds.
Supraorbital Pressure: Apply pressure at supraorbital notch.
Sternal Rub: Generally not recommended due to potential for bruising.
Peripheral Stimuli:
Apply pressure to a fingernail bed to test spinal cord response.
Scoring System
Score Range: 3 (lowest) to 15 (highest).
Score of 15: Patient is alert/awake.
Score of 8 or less: Patient is in a coma and usually requires intubation.
Score of 3: Deep coma, severe head injury, high risk of death.
Brain Injury Classification
Severe Injury: 3-8
Moderate Injury: 9-12
Mild Injury: 13-15
Points Distribution
Vision (Eye Opening) - Max 4 points
Spontaneous: 4 points
To verbal command: 3 points
To pain: 2 points
No response: 1 point
Not testable: NT
Verbal Response - Max 5 points
Oriented: 5 points
Confused: 4 points
Inappropriate words: 3 points
Incomprehensible sounds: 2 points
No response: 1 point
Not testable: NT
Motor Response - Max 6 points
Obeys commands: 6 points
Localizes pain: 5 points
Withdraws from pain: 4 points
Abnormal flexion (decorticate): 3 points
Extension (decerebrate): 2 points
No response: 1 point
Not testable: NT
Interpretation and Reporting
Sub-Scores Reporting: Important to report not just total GCS but also sub-scores (E, V, M).
Considerations: Consider factors like paralysis, intubation, facial injuries, sedation that might affect scoring.
Adjust interpretation based on these factors (e.g., intubated patients).
Example Scenario
Example Calculation:
Eye opening (E) upon nail bed pressure: 2
Verbal response (V) making sounds: 2
Motor response (M) localizing pain: 5
Total GCS Example Score: 9 points
Final Notes
Consistent application and interpretation based on specific patient circumstances are crucial for accurate assessment.
Practice regularly with provided resources like quizzes to improve understanding and application of GCS.