Lecture on the Glasgow Coma Scale (GCS)

Introduction

• Presenter: Sarah, Registered Nurse (RN)
• Platform: RN.com
• Content: Explanation of the Glasgow Coma Scale (GCS) and its application
• Additional Resource: A free quiz available after the video

Purpose of the Glasgow Coma Scale

• Assess Level of Consciousness (LOC): Evaluate how alert and responsive a patient is.
• Application: Used for patients with traumatic brain injuries or altered brain functioning.
• Score Utilization: GCS is expressed as a numerical score (e.g., GCS of 7 or 10).
• Importance of Baseline Score: Get initial GCS to compare changes over time which indicate if the patient's condition is improving, stable, or deteriorating.

Components of the GCS

• Three Responses Assessed:
  • Eye Opening Response
  • Verbal Response
  • Motor Response
• Stimuli Types:
  • Verbal Stimulus
  • Pressure/Painful Stimulus: Central and Peripheral stimuli

Pressure/Painful Stimuli Techniques

• Central Stimuli:
  • Trapezius squeeze (apply pressure with fingers)
  • Supraorbital pressure (pressure near eyebrow notch)
  • Caution: Avoid if facial injuries present
• Peripheral Stimuli:
  • Pressure on fingernail bed (tests spinal cord response)

GCS Scoring System

• Score Range: 3 to 15
• Interpretation:
  • 15: Fully alert and awake
  • 8 or less: Patient in a coma, possible need for intubation
  • 3: Severe injury, high risk of death
• Injury Severity Grouping:
  • Severe: 3-8
  • Moderate: 9-12
  • Mild: 13-15

Scoring Details

• Eye Opening Response (E): Max 4 points
• Verbal Response (V): Max 5 points
• Motor Response (M): Max 6 points
• Not Testable (NT): Used when responses cannot be tested due to patient conditions like paralysis or intubation

Detailed Breakdown of Each Response

Eye Opening Response

• 4 Points: Opens eyes spontaneously
• 3 Points: Opens eyes to verbal stimulus
• 2 Points: Opens eyes to pressure stimulus
• 1 Point: No eye opening
• NT: Eyes swollen shut or untestable

Verbal Response

• 5 Points: Oriented answers
• 4 Points: Confused answers
• 3 Points: Inappropriate words
• 2 Points: Incomprehensible sounds
• 1 Point: No verbal response
• NT: Not testable due to intubation etc.

Motor Response

• 6 Points: Obeys commands
• 5 Points: Localizes pain
• 4 Points: Withdraws from pain (normal flexion)
• 3 Points: Abnormal flexion (decorticate posturing)
• 2 Points: Extension to pain (decerebrate posturing)
• 1 Point: No motor response
• NT: Not testable due to sedation/paralysis

Practical Application

• Example: Calculate GCS for a patient with specific responses
  • Eye response to pressure: 2 points
  • Verbal response as sounds: 2 points
  • Motor response localizing pain: 5 points
  • Total GCS: 9

Conclusion

• Understanding GCS helps in evaluating and monitoring patients with potential brain injuries.
• Accurate interpretation of scores and sub-scores is crucial for patient assessment.
• Reminder: Access the quiz to test your knowledge.