LEVEL OF CONSCIOUSNESS

By tanti a.b
 GCS / GLASGOW COMA SCALE
GCS or glasgow coma scale Is :

1. Neurological Scale assessment aims to give reliable

and objective way to recording the level of
consciousness state

A measurement process on a person state of awareness

and response to stimuli from the environment. The
level of awareness are divided into :
The level of awareness are divided into

1. Qualitative measurement

2. Quantitative measurement
 Qualitative measurement
1. Compost mentis ( fully consciousness / fully awareness GCS Score : ( 15-14 )
state of the patient is fully conscious both environment and him or her self

2. Apathy / Apathetic : GCS Score ( 12 - 13 )

the state of patient where seemingly indifferent and reluctant to the
environment

3. Delirium ( mengigau ) : GCS Score ( 10-11 )

The state of patient has decreased consciousness with motoric disorder and
disturbed sleep wake cycle

4. Somnolent ( sleepy ) : GCS Score ( 7-9 )

The state of sleepy patient who can recover if stimulated , but if the
stimulation stops, the patient will sleep again
5. Stupor ( deep Sleep )/ Deep Sleepy patient ( 5-6 )

6. Semi coma / Pre coma / Mild coma GCS Score : ( 4 )

The state of the patient has a decreased consciousness, that
doesn’t provide a stimulation response to the verbal stimuli,
and unable to wake at all, but the response to pain is
inadequate as well as reflexes ( pupils and cornea ) is still
good

7. Coma : GCS score : ( 3 )

The state of the patient has a very deep decline in
consciousness , there is no response to pain or movement

8. Dead : GCS score ( 3 )

 5. Coma / comatose
Patients can be awaken. No response to any
stimulus ( no corneal reflex, and vomiting )
may also no puppilary response to light. GCS :
less than 3
 II. Quantitative measurement
In this measurement , will assess the patient’s
responses on 3 things :

1. Eye opening ( E )
2. Verbal ( V )
3. Motoric response ( M )
 Gcs test result
1. Eye response ( 1- 4 )

1. Score 4 : open eyes spontaneously

2. Score 3 : With sound stimuli ( ask the
patient to opened her eyes )
3. Score 2 : pain response ( provide painful
stimuli , such as tapping finger
nails, of pinch around chest area
4. Score 1 : no response
 2. Verbal response ( 1 – 5 )
1. Score 5 : good orientation ( asking about name, time and place, can answer it
precisely )

2. Score 4 : confused, talk screw ( repetition , frequently asked ) disorientation to time

and place, taking disorganized, often asking again and again, disorientation of place
and time.

3. Score 3 : words are not clear( Speech is not very clear enough ), inappropriate word,
but the words are still can clear : but it is not in one sentence. We called it : rave or
delirious. Patient can say : mom, father, pain, ouch, etc

4. Score 2 : incomprehensible words , unable formulate words, meaningless voice

( moaning )

5. Score 1 : no response, no sound.

 Motoric/ movement response
1. Score 6 : follow orders ( open eyes, raise your hand, touch my
hand )
2. Score 5 :Localized pain ( reach and keep the current stimulus
when given painful stimuli ( hands toward the pain area )/
reach and keep stimulus when give pain stimulation
3. Score 4 : withdrawn ( dodge / pull extremity or body away from
the current stimulus when given pain stimulus./ pulls
extremities or body away from stimulus when given pain
stimuli
4. Score 3 : Abnormal Flexion : ( one or both hands rigid position
over the chest and leg extension when given painful stimuli
5. Score 2 : abnormal extension ( one or both extension arms at
patients side, ( clenched fingers and leg extension when given
painful stimuli
6. Score 1 : No response
 Vocabularies ;

1. Grimace : meringis
2. Regain consciousness / mendapatkan kesadaran kembali
3. Groan : mengerang / moanning
4. In Appropriate word : meracau
5. Restless : gelisah
6. Precisely : tepat = exact
7. Discomfort : tidak nyaman
8. Rave : meracau / mengigau
9. Delirious : Mengigau
10.Indifferent : mengacuhkan / melalaikan
11.Reluctant : enggan / malas
Level of consciousness
 Case study :
Mr. A, 36 Yeard old was admitted to hospital after
traffic accident. On admission nurse obtain the
following data : nurse tried to wake him up by voice
but there was no response, and then nurse push down
the patient’s finger nail bed. He opened his eyes.
Client only moaning, mom, ouch,..Help, and abnormal
flexion.
1. How is his GCS :……….
2. How is his consciousness level ?