Understanding Glasgow Coma Scale (GCS) - Lecture Notes

Introduction

• Presenter: Paramedic Coach
• Objective: Understand and memorize the Glasgow Coma Scale (GCS).
• Key Mnemonic: EVM 456

Example Question

• Scenario: 84-year-old female fallen, speaking with scattered inappropriate words, withdraws from pain, eye-opening on verbal command.
• GCS Calculation:
  • Verbal: Inappropriate words = 3 points
  • Motor: Withdraws from pain = 4 points
  • Eye Opening: On verbal command = 3 points
  • Total GCS: 10

GCS Breakdown

Mnemonic: EVM 456

• E for Eye Opening (max 4 points)
• V for Verbal Response (max 5 points)
• M for Motor Response (max 6 points)
• 1 1 1 Rule: Each category’s minimum (unresponsive) score is 1

Scoring System

Eye Opening

1. 4 - Spontaneous: Eyes open spontaneously.
2. 3 - Verbal Command: Eyes open to verbal command.
3. 2 - Pain: Eyes open to pain stimulation.
4. 1 - None: No eye opening.

Verbal Response

1. 5 - Oriented: Communicating normally (e.g., talking in full sentences).
2. 4 - Confused: Full sentences but confused (e.g., dementia patient).
3. 3 - Inappropriate Words: Random or unrelated words.
4. 2 - Incomprehensible Sounds: Grunting or moaning, not forming words.
5. 1 - None: No verbal response.

Motor Response

1. 6 - Obeys Commands: Follows verbal commands.
2. 5 - Localizes Pain: Points to or tries to remove source of pain.
3. 4 - Withdraws from Pain: Pulls away from painful stimulus.
4. 3 - Abnormal Flexion: Decorticate posturing (arms flexed to the core).
5. 2 - Abnormal Extension: Decerebrate posturing (extension).
6. 1 - None: No motor response.

Key Points

• 15: Perfect GCS score; alert and oriented.
• 3: Lowest GCS score; unresponsive (e.g., cardiac arrest).
• Goal: Understand middle scores to differentiate levels of consciousness and responsiveness.

Conclusion

• GCS Utilization: Essential for assessing consciousness in medical scenarios.
• Educational Resources: Consider additional study resources for further EMS education and preparation for NREMT exams.

• Call to Action: Follow up with additional resources available for lifetime access and community support.