Glasgow Coma Scale (GCS) Lecture Notes

Introduction

• Presenter: Sarah, from RegisterNurseRN.com
• Topic Overview: Understanding the Glasgow Coma Scale (GCS) and its application in assessing a patient's level of consciousness.
• Additional Resource: Free quiz available through the video description to test understanding.

Purpose of the GCS

• Assess patient's level of consciousness.
• Important for evaluating patients with traumatic brain injuries or altered brain function.
• Provides a numeric score (e.g., GCS of 7 or GCS of 10).

Importance of Baseline Score

• Establish a baseline GCS score upon initial assessment.
• Regular reassessment is crucial to monitor improvements or deteriorations.
• Changes in consciousness can indicate underlying issues.

Components of the GCS

• Three Response Categories:
  1. Eye Opening Response
  2. Verbal Response
  3. Motor Response
• Each response is assessed using specific stimuli (verbal or physical).

Types of Stimuli

• Central Stimuli: Apply pressure to body core; tests brain's response.
  • Methods: Trapezius squeeze, supraorbital pressure.
  • Trapezius Squeeze: Use fingers to apply pressure to trapezius muscle.
  • Supraorbital Pressure: Apply pressure to notch above the eyes.
• Peripheral Stimuli: Apply pressure to extremities (e.g., fingernail bed); tests spinal cord response.

Scoring the GCS

• Total score ranges from 3 to 15.
  • 15: Fully alert and oriented.
  • 8 or less: Indicates coma, often requiring intubation.
  • 3: Severe coma, high mortality risk.
• Score Categories:
  • Severe Injury: 3-8
  • Moderate Injury: 9-12
  • Mild Injury: 13-15

Subscores

• Each of the three responses has specific points:
  • Eye Opening (E): Maximum 4 points
  • Verbal (V): Maximum 5 points
  • Motor (M): Maximum 6 points
• Total GCS is the sum of these subscores.

Evaluating Each Response

Eye Opening Response

• 4 Points: Opens eyes spontaneously.
• 3 Points: Opens eyes in response to verbal command.
• 2 Points: Opens eyes in response to pain.
• 1 Point: No eye opening.

Verbal Response

• 5 Points: Oriented and correct answers.
• 4 Points: Confused answers.
• 3 Points: Inappropriate words.
• 2 Points: Incomprehensible sounds.
• 1 Point: No verbal response.

Motor Response

• 6 Points: Follows commands.
• 5 Points: Localizes pain.
• 4 Points: Withdraws from pain.
• 3 Points: Abnormal flexion (decorticate posture).
• 2 Points: Extension response (decerebrate posture).
• 1 Point: No motor response.

Considerations

• Be aware of factors affecting response (e.g., paralysis, intubation).
• Use "NT" (not testable) when unable to assess a component properly.
• Consider subscore significance when reporting.

Example Calculation

• Scenario: Patient opens eyes to pressure (E=2), makes sounds to verbal questions (V=2), localizes pain (M=5).
• GCS Score: Total of 9.

Conclusion

• GCS is a critical tool in assessing brain function and consciousness.
• Ensure thorough understanding and appropriate use of the scale.
• Don't forget to complete the quiz for self-evaluation.