hello my name is Mark Kimi and I am a register nurse and I will be doing a session with you folks on the Glascow Coma Scale this is episode seven in our Series so if you haven't seen the first six you can see them on think think iic uh at the climic connect site so my name is Mark as I said I'm a registered nurse uh I am the president and CEO of climic connect which is a climic reviews session uh company we review for enlex and we help nurses prepare for their profession we launched climic connect as sort of a site for you guys to get a lot of information about nursing in general and the enclex specifically what we're doing in these sessions is we're doing what we call a walk through the Blue Book now the blue book is a book that I wrote that has the factual content that is essential to know for the enlex RN and PN tests this book here now we this book has like 200 different topics and we're only hitting a couple of week but we're walking through them we're giving you a little bit of a taste of it and hitting essential points there's a lot more in the Blue Book than what we're going to be covering uh if you don't have a blue book you can get one on online at uh Amazon if you come to our live review you get one if you come to uh if you get our uh on demand program on the clinic website uh you also get one uh but if you don't have one you will still learn some things but we will refer to the book as we go through so walk through the blue book today uh this topic of the Glasco Coma Scale is under the neurological examination topic on chapter three or four it's on a pro health promotion and it's on page 53 of the addition that is most current so let me talk a little about the Glascow Coma Scale do nurses need to know the glas gal Coma Scale absolutely you do so let me give you a little history of the glas gal Coma Scale it was developed in 1974 at the University of Glasgow in Scotland hence the name Glasgow Coma Scale now here's the reason why did they develop this scale well I've been a nurse for a long time 40 some years and I started out in neurological nursing and back in those days before the glasgal Coma Scale we would report a person's level of Consciousness using terms like obtunded lethargic semicom sleepy slow to arouse well those are very subjective words and they don't allow you to compare patient over time accurately because if I said someone is Sleepy do you know what that means might not you have a different definition of sleepy than me or lethargic what does it take to be lethargic you know what I mean does the guy have to like wait 10 seconds before they respond to be lethargic or is it they just don't answer right away or their answer is very slow in wording it's because no one really knows exactly what those words mean so it was really bad back then before the glass galcom scale because we had no way of comparing patients conditions over time neurologically because we just had those vague subjective words now the glass galcom scale tries to add objectivity to neurological assessment so that you can compare Patient to Patient time versus time in the same patient so let's talk about the procedure of the glass Goma scale it measures three things actually four but we'll add the fourth but the basic glass Gooma scale measures best eye response best verbal response and best motor response so I verbal and motor those are what we assess so you get three scores one for the I which is a total of four one for the e mo e um motor I'm sorry verbal response which is a total of five and a score for the best motor response which is six so let me go over that again I the best you can get is a four verbal the best you can get is a five and motor the best you can get is a six on the those subscales so if you add four + 5 that's N9 add six that's 15 so the possible top score on a Glasgow Coma Scale is a 15 and that person is totally fully alert oriented and extremely healthy neurologically now the higher the score obviously the better off the person is and the lower score the worse off they are so you can say hey he went from an eight to a seven he went from a 10 to an 11 and see that tells us something and then we can look at the subsc scourse and see where it changed was it motor was it I was it verbal and do you see how much better that is than lethargic you know so it's a great score now for enlex and for your practice you do not need to memorize the four subscales and the points for the I the five subscales and the points for the verbal and the six sub points and scores for the motor that will be given to you you just need to know what the scores mean and what how they're determined so how do you get the scor how do you actually interact with the patient to elicit a score well for IE you look at see how they eye open it's not pupils it's eye opening do they open their eyes so if you just say their name and they open their eyes that's a top score if you apply painful stimulus to them and they don't even Flex their eyelids even a bit that's a low score that's a one okay so but it's the best and the same thing with verbal if they respond to you immediately that's the top score if they don't respond at all that's a low score that's a one same thing with motor if they're freely moving about without any stimulation like I am here that's a high score if they don't move at all ever even to pain that's a low score now the key is this this is probably the most important thing to carry away from this talk these scores you give them are their best response their best one that means if you press their fingernail twice three times three times let's say and one of those times you get a little bit of a a blink in the eye you give them that score the best one the blink in the eye don't say well the most of the time they didn't open their eyes so I'm giving them the lower score no no if they if they even slightly spontaneously move a finger like this that gets a full score they don't have to be going like that to get a full score okay so best eye response best verbal best motor all right now as I said before you get a total of 15 points for a fully oriented and alert patient if it's under eight eight or under they are severely uh brain injured or impaired okay so you you don't want it to be under eight it's considered to be comos eight and lower maybe say like 12 to n that would be moderate brain injury you know and then like a 13 and a 14 that'd be minimal brain injury so it kind of changes when it hits a dozen points 12 that's moderate and then down to eight where it becomes severe okay now one of the things that the glasow Coma Scale did not take into account was pupil reactivity your pupils and aren't those real important in nuro so around 2011 some guys in Scotland came up with a a way to incorporate pupils but then it was improved again in 2018 just five six years ago so what is that now now what we have is the GSC CL Goma scale minus PRS pupilary response okay score pupilary response score PRS so it's GSC minus PRS so now you have to know the pupilary response score got it okay now you know how to test pupil shine a light in look to see if one reacts or they both react right brisk all that okay okay now you can give a zero a one or a two on a pupilary response score zero means both eyes respond appropriately they they constrict with light okay a one means one pupil does and the other pupil doesn't you give them a one if neither pupil if if neither one opens you give them a two so a PRS is different than a gscs glasow coma the higher score the better pupilary response score the higher score the worse okay that kind of confusing okay but what you're doing is it's GCS minus the PRS so if you get a 12 GCS and neither pupil responds neither one does you give them a two so it's a 12 minus 2 which gives him a 10 did you got that so what would it be if you got an eight and one pupil reacted and the other didn't what score would that be well 8 minus 1 is 7 so remember it's always minus the PRS you're going to see GCS minus PRS that minus is not Dash it means subtract minus okay 0 one two so your score should be 15 because 15 both pupils react that's a zero so you subtract nothing so you get a 15 got that so I hope that helps because that's very very important to know don't forget uh if you have friends that would benefit from things like this tell them to go to think ific set up an account and join climic connect and weekly you can get these sessions that I do and this is episode seven so there have been six previous ones thank you for this opportunity and and I wish the best for you