Glasgow Coma Scale

1
Glasgow Coma Scale

• Aaron Rund, MSIII
• Surgery Rotation
• 3/20/07

2
Clinical correlate

• A 20 year old white male presents to the team
  physician unconscious 5 minutes after missing the
  pole vault pit and landing with the occipital
  region of his head hitting asphalt. After
  assessing the ABCs and finding them intact, the
  patients level of consciousness was evaluated.
  The patients eyes, initially closed, opened to
  the sound of his name, and when asked where he
  was, the patient responded with my shoes to
  change. The patient moved all of his fingers
  and toes when prompted.
• What is this patients score on the
• Glasgow Coma Scale?

3
Glasgow Coma Scale What is it?

• Developed by neurosurgeons in 1974
• Quantifies level of consciousness
• Acute brain damage traumatic and/or vascular
  injuries
• or infections
• Metabolic disorders hepatic or renal failure,
  hypoglycemia, diabetic ketosis, toxic ingestion
• Assess initial level of consciousness
• Assess changes in level of consciousness
• Helps guide treatment and predict outcome

4
Glasgow scoring
5
Verbal response in children
6
Posturing

• Decorticate
• Upper extremity flexion with lower extremity
  extension
• Mesencephalic region or corticospinal tract
  damage
• Decerebrate
• Upper and lower extremity extension
• Brainstem damage below the red nucleus
• Progressive
• Uncal or tonsilar herniation

7
Stimulation

• Eye opening
• Name spoken loudly
• Verbal response
• Person, place, time
• Motor response
• Fingernail bed pressure
• Supraorbital pressure
• Hand crosses midline and above clavicle
• Sternal rub

8
Glasgow score

• Score range
• Extubated 3 15
• Intubated 3 11T
• Clinical presentation
• Normal GCS 15
• Comatose GCS 8
• Dead GCS 3
• Grading of head injury
• Minor GCS 13
• Moderate GCS 9 12
• Severe GCS 8
• Example report
• GCS 9 E2 V4 M3 at 0735

9
Prognosis
10
Prognosis variability

• Past medical history
• Age, previous neurological problems
• Injury
• Type and location, depth, duration of coma,
  presence of low blood pressure, oxygen levels
• after the injury
• Current findings
• Physical examinations, radiological studies of
• the brain

11
Clinical correlate (revisited)

• The patients eyes, initially closed, opened to
  the sound of his name.
• Eye opening
• 3
• When asked where he was, the patient said my
  shoes to change.
• Verbal response
• 3
• The patient moved all of his fingers and toes
  when prompted.
• Motor response
• 6
• Score
• GCS 12 E3 V3 M6 at 1634
• Head injury severity
• Moderate