GLASGOW COMA SCALE(GCS)-The Glascow Coma Scale (GCS) is a scale designed to objectively grade

the level of consciousness of an individual. It was initially created in 1974 to assess head injury patients, but its use has expanded to all acutely ill medical and trauma patients. -The GCS is the summation of scores for eye, verbal, and motor responses. The minimum score is a 3 which indicates deep coma or a brain-dead state. The maximum is 15 which indicates a fully awake patient (the original maximum was 14, but the score has since been modified). -A scale that is used to assess the severity of a brain injury, that consists of values from 3 to 15 obtained by summing the ratings assigned to three variables depending on whether and how the patient responds to certain standard stimuli by opening the eyes, giving a verbal response, and giving a motor response, and that for a low score (as 3 to 5) indicates a poor chance of recovery and for a high score (as 8 to 15) indicates a good chance of recovery

For best eye responses, there are 4 possible scores:

1. No eye opening 2. Eye opening in response to pain-(pressure to fingernail bed or sternal rub) 3. Eyes opening to speech 4. Eyes opening spontaneously

For best verbal response, there are 5 possible scores:

1. No verbal response 2. Incomprehensible sounds (such as moaning) 3. Inappropriate words 4. Confused speech 5. Oriented

For best motor response, there are 6 possible scores:

1. No motor response 2. Extension to pain 3. Abnormal flexion to pain 4. Withdrawal to pain 5. Localizes to pain 6. Obeys commands

Once the individual eye, verbal, and motor responses are summed, the final score indicates the following level of brain injury:
Minor, GCS 13 Moderate, GCS 9 - 12 Severe, with GCS 8

HOW TO PERFORM GLASGOW COMA SCALE? 1.Assess the patient's eye opening. A total of 4 points may be given for eye opening. A patient who opens their eyes spontaneously, such as an alert patient sitting in a chair, would be scored a 4. If the patient is asleep or lying with eyes closed, but opens them upon command, a 3 is awarded. If the patient only opens their eyes to painful stimulus, such as running the tip of blunt scissors along the bottom of the foot, or a pinch, the patient is scored a 2. A patient who does not open their eyes no matter what is given a 1. Some patients may rouse if a very bright penlight is held a few inches from their eyes in order to induce a response. 2.Ask the patient questions, or engage in routine conversation to assess verbal response. A patient who engages in normal, appropriate conversation would be given a 5 on the GCS. A patient who makes appropriate conversation but is confused, such as an Alzheimer's patient, would be scored as a 4. The patient who makes inappropriate conversation, such as answering a question on an entirely different subject, would be given a 3. If the patient cannot make conversation, but instead has very garbled speech or makes incomprehensible sounds,they would be given a 2. The patient who is unable to speak or make any sounds for any reason, such as being on a ventilator with a breathing tube in their mouth, would be given a 1. 3.If the patient is lying still, ask him to wiggle his feet or raise his left arm and assess the response. A patient who moves arms and legs either spontaneously or on command is given a 6. If the patient displays purposeful movement with a painful or unpleasant stimulus, such as trying to push it away, the patient is given a 5. The patient who only withdraws away from pain with no other response is given a 4. A score of 3 is given to the patient demonstrating decorticate posturing, in which the patient's extremities are drawn inward toward the center of the body. If the patient is in the decerebrate posture, the extremities are turned away from the body, and the score is 2. The lack of any movement or posturing is given a 1. 4.Record the GCS findings in the patient's chart. Assess with routine physical assessment, or whenever a change in GCS is noted. Report findings to physician as indicated. Glasgow Coma Scale Eye Opening

Spontaneous To loud voice To pain None

Verbal Response

4 3 2 1

Oriented Confused, Disoriented Inappropriate words Incomprehensible words None

Motor Response

5 4 3 2 1

Obeys commands Localizes pain Withdraws from pain Abnormal flexion posturing Extensor posturing None

6 5 4 3 2 1