Glasgow coma scale Dr. S. Parthasarathy - PowerPoint Presentation

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Glasgow coma scale

Dr. S. Parthasarathy

MD., DA., DNB, MD (

Acu

),

Dip. Diab.DCA, Dip. Software statistics

PhD (

physio

)

Mahatma

gandhi

medical college and research institute,

puducherry

, India

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Some history

Teasdale and

Jennett

in 1974

the Glasgow Coma Scale or GCS is a

neurological scale

that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment.

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First use !!

as a method of describing states of impairment within the consciousness continuum

a quick, practical standardized system for assessing the degree of consciousness in the critically ill and for predicting the

duration and ultimate outcome

of coma, primarily in patients with head injuries

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Original authors

Changing level of consciousness – development of complications

Depth of coma ---for ultimate recovery which can be expected

Assessment at 6 h following head trauma.- influence of alcohol, drugs, hypoxia gone

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The scale involves

eye opening,

verbal response,

and motor response, all of which are evaluated independently according to a

rank order that indicates the level of consciousness and degree of dysfunction

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Electronic V

oting

M

achine

E – 4

V – 5

M- 6

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The sum of the numeric values for each parameter can also be used as an overall objective measurement.

E + V + M

15 indicative of no impairment,

3 compatible with brain death, and

7 usually accepted as a state of coma.

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EVM – separate analyses

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Localize

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Withdrawal

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Flexor

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Extensor

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Clinical uses

.

The test score can also function as an indicator for certain diagnostic tests or treatments, such as the

need for a computed tomography scan, intracranial pressure monitoring, and intubation.

The scale has a

high degree of consistency

even when used by staff with varied experience

.

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Clinical uses

The results may be plotted on a graph to provide a visual representation of the improvement, stability, or deterioration of a patient's level of consciousness, which is crucial to predicting the eventual outcome of coma.

various medical conditions including drug

overdose, infection, spontaneous intracranial bleeding, seizures and hepatic encephalopathy

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v

Time

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Head Injury Classification

Severe Head Injury----GCS score of 8 or less Moderate Head Injury----GCS score of 9 to 12 Mild Head Injury----GCS score of 13 to 15

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Clinical uses

To facilitate understanding, clear description and communication between clinicians

For research purposes

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Prognosis

The GCS motor score 2 weeks after injury was statistically significantly associated with the 12-month functional outcome in TBI survivors.

Motor response was the most useful predictor among the GCS components with respect to the long-term functional outcome in patients with severe TBI

. --

Controversial !!

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In stroke !!

The GCS verbal component may be misleading in acute stroke:

a focal neurological deficit leading to dysphasia could affect the score, independently of level of consciousness.

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Which will confuse GCS ??

Ocular trauma , Cranial nerve injuries ,

edema of tongue

Facial trauma

Injuries (spinal cord, peripheral nerves, extremities)

Pain , Intoxication (alcohol, drugs)

Medications (

anaesthetics

, sedatives)

Dementia , Psychiatric diseases

Developmental impairments

Intubation,

tracheostomy

,

Laryngectomy

Mutism

Hearing impairments

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Detailed breakdown of GCS components

Eyes

GCS 0f 3- 4 – brain stem may be ok

but 2 or less ??

Vegetative state can have rarely spontaneous reflexive eye opening !!!

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Verbal

Presence of speech implies a high level of integration in the nervous system

Motor scores of 6, 5 and 4 imply the presence of cerebral function and the ability to react appropriately to a noxious stimulus.

2 or 3 – may be brainstem ??

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Children – verbal response

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Compare with other scores

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FOUR score

The FOUR (Full Outline of

UnResponsiveness

)

score, not surprisingly, has four components, each of which has 4 as the maximal grade.

Eye, motor, brainstem reflexes, respiration

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AVPU score

The GCS was compared to the AVPU

A

lert, responds to

V

erbal stimuli, responds to

P

ainful stimuli,

U

nresponsive score and median GCS scores of 15, 13, 8 and 3 corresponded to AVP and U respectively

A, V, P, U 15, 13, 8, 3

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WFNS GCS motor deficit

I 15 absent

II 14- 13 absent

III 14 – 13 present

IV 12 -7 present or absent

V 6 -3 present or absent

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Conclusions

All the advantages

But

Concerns have been raised about the potential for misleading levels of precision engendered by the use of the GCS,

and the use of simpler scales suggested.

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Thank you all