PSY321 - Glasgow Coma Scale

(Teasdale & Jennett (1974)

Glasgow Coma Scale (CGS)

Used in acute situations to assess patients level of consciousness Need to record initial examination results accurately This is only achieved using the same questions each time patient is assessed ! Treatment decision may depend on whether subsequent examinations show improvement/ deterioration

PSY321 Glasgow Coma Scale

12 August 2005

PSY321 Glasgow Coma Scale

12 August 2005

Components of the GCS

There are three components to the GCS: Best eye opening Best motor response Best verbal response Each is evaluated independently of the other two components. ALWAYS SCORE THE BEST RESPONSE FOR THE PATIENT
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Best Eye Opening (4 1)

Assessment of eye opening shows that arousal mechanisms located in the brain stem are functioning. If patients have their eyes closed, their state of arousal can be assessed by the degree of stimulation needed to get them to open their eyes.
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Eye Opening Response

4 = eyes open spontaneously when a person approaches the bedside. Indicates intact arousal mechanism. 3 = eyes open to either spoken or shouted verbal stimulation. 2 = eyes open to a painful stimuli (to be used only when it is clear patient will not open eyes to verbal stimuli). 1 = failure to open eyes regardless of stimuli.
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Eye Opening
If there is damage to the occulomotor nerve from trauma, the patient may not be physically able to open his or her eye. The occulomotor nerve is responsible for movement of the eyelid and causes the eye to open.

PSY321 Glasgow Coma Scale

12 August 2005

Best Motor Response (6 1)

Obeys commands (6) Localises to pain (5) Withdraws from pain (4) Abnormal flexion (3) Extension (2) No response (1)

Obeys Commands (6)

Patients are aware of their environment, have understood the observer's instructions, and are able to carry them out. Examples of possible commands are 'lift up your arms' or 'hold up your thumb'. If patients are asked to 'squeeze my hands', they must also be asked to release their grip.

PSY321 Glasgow Coma Scale

12 August 2005

PSY321 Glasgow Coma Scale

12 August 2005

Localises to Pain (5)

This is a response to a central painful stimulus. It involves the higher centres of the brain, the cerebral hemispheres or cerebrum. It tells the body to do something about removing the source of the pain - usually a motor response such as moving an arm towards the source of the pain in order to remove it and stop the pain from continuing.
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Withdraws from pain (4)

Patients flex or bend their arm towards the source of the pain, but do not actually localise or try to remove the source of the pain.

PSY321 Glasgow Coma Scale

12 August 2005

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Abnormal Flexion (3)

Patients flex or bend the arm at the elbow and rotate the wrist, resulting in a spastic posture in response to a central painful stimulus. It is an abnormal response and indicates severe cerebral damage and an interruption of nerve pathways from the brain's cortex to the spine.
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Abnormal Flexion

12 August 2005

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Extension (2)
In response to a central painful stimulus, patients will extend or straighten an arm at the elbow, or may rotate the arm inwards. Abnormal response and emanates from the brain stem. It shows that patients are not able to send information to and from the cerebrum due to damage to the brain stem.
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Extension

12 August 2005

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Best Verbal Response (5 - 1)

Verbal response assesses consciousness by determining whether a person is aware of him/herself and the environment. It involves the second aspect of consciousness - cognition.

Orientation
There are six specific questions in the original GCS
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What is your name Where are you Why are you here What month are we in? What year are we in? What season are we in?
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PSY321 Glasgow Coma Scale

12 August 2005

PSY321 Glasgow Coma Scale

Confusion (4)
A patient may be able to hold a conversation with the observer but responses are inappropriate or disoriented. This category is sometimes referred to as 'sentences', which is a more specific assessment used by neurocentres. A patient who talks in sentences, is confused but not orientated, and will score four.
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Inappropriate Speech (3)

Does not carry on conversation, poor attention span, uses inappropriate words and phrases. Random/confused/repetitive.

PSY321 Glasgow Coma Scale

12 August 2005

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Incomprehensible Speech (2)

Patients are less aware of their environment and their verbal response is in the form of incomprehensible sounds. Moan or cry, unable to articulate. The observer may now have to use both a painful and verbal stimulus to get a response.

Levels of Consciousness
GCS ratings correlate with brainstem and higher cortical functioning: GCS 13 - 15: mild traumatic brain injury GCS 9 -12: moderate traumatic brain injury GCS 3 8: severe traumatic brain injury

PSY321 Glasgow Coma Scale

12 August 2005

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PSY321 Glasgow Coma Scale

12 August 2005

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