Glasgow Coma Scale(GCS

bladder dysfunction

10 [Ref:Bailey & Love 25/e p301]

• Glasgow coma scale is used to determine the conscious level of the patient
• It is based on EVM i.e. Eye Opening, Verbal response & Motor response

• Ranges from 3 to 15.
• A score of 7 or less is classed as coma
• A score of 9 or more excludes coma

In this patient: 

The best prognostic factor for head injury is glasgow coma scale.

The GCS is determined by adding the scores of the best responses of the patient in each of three categories such as eye opening, best motor response and verbal response. Maximum score is 15 and minimum score is 3.

Traumatic brain injury is classified according to GCS score as mild (score 14-15), moderate (scores 9-13) and severe (scores 3-8).

Over 85% of patients  with scores of 3 or 4 die within 24 hrs.

Ref: Harrison’s Principles Of Internal Medicine, 16th Edition, page 2450,2451 ; Anaesthesia, Pharmacology, Intensive Care and Emergency Volume 23  By Antonino Gullo, page 305

In severe head injury, the clinical features of eye opening, motor responses of the limbs, and verbal output have been found to be generally predictive of outcome.

These three responses are assessed by the Glasgow Coma Scale; a score between 3 and 15 is assigned.

Over 85% of patients with aggregate scores of

Ref: Ropper A.H. (2012). Chapter 378. Concussion and Other Head Injuries. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison’s Principles of Internal Medicine, 18e.

On trying to rouse the patient by asking a simple question, no response is given a score of 1 under the GCS scale.

Glasgow coma scale consists of three elements – Eye response, Verbal response and Motor response.

Eye opening has a maximum score of 4, Verbal response has a maximum score of 5 and Motor response has a maximum score of 6. Thus the maximum score is 15 and the minimum score is 3.

Ref: Bailey and Love Short Practice of Surgery, 25th Edition, Page 301.  

Glasgow coma scale consists of three elements – Eye response, Verbal response and Motor response.

A conscious person has spontaneous eye opening (score of 4), oriented, converses (score of 5) and obeys commands (score of 6). So the total score is 15.

Ref: Bailey and Love Short Practice of Surgery, 25th Edition, Page 301 .

Glasgow coma scale includes aspects of eye opening, verbal and motor response.

Glasgow Coma Scale for Head Injury:

Coma score = E + M + V. Patients scoring 3 or 4 have an 85% chance of dying or remaining vegetative, while scores >11 indicate only a 5–10% likelihood of death or vegetative state and 85% chance of moderate disability or good recovery. Intermediate scores correlate with proportional chances of recovery.

Ans. is ‘d’ i.e., Sensory response 

Ans. is ‘a’ i.e. Glasgow coma scale 

Ans is A(Eye opening), B(Motor response)

Ans. is ‘d’ i.e., 10-15

Ans. is ‘c’ i.e. pupil size 

Ans. is ‘c’ i.e. 15 

Ans. is ‘a’ i.e., Range from 6-12 

• Glasgow coma scale is used to determine the conscious level of the patient
• It is based on EVM i.e. Eye Opening, Verbal response & Motor response

Ans is ‘c’ i.e. 10

Ans. is ‘d’ i.e., Increased Score indicates poor prognosis 

Ans. is ‘a’ i.e., No response 

Answer is A (No response):

On trying to rouse the patient by asking a simple question, no response is given a score of 1 under the GCS scale.

Glasgow coma scale:

Maximum score is Y : 15

Minimum score is ^Q :03

Answer is C (15):

The answer is B (3):

Glasgow coma scale for head injury:

verbal response

eye response

best motor response

Answer is A (Glasgow coma scale):

Amongst the option provided GCS is the single best answer of choice.

Determining the patient prognosis after TBI (Traumatic Brain Injury) is difficult and complex.

• Several independent variables have been identified that correlate with severity.
• Most studies have indicated Glasgow Coma Scale in the field and at arrival at the emergency department as a highly predictive indicator of prognosis. Harrison 17^th / 2601

In severe head injury eye opening, the best motor response and verbal output have been found to be roughly predictive of outcome.

There have been summarized using the Glasgow coma scale.

Coma score = E + M + V

• Patient scoring 3 or 4 have an 85% chance of dying or remaining vegetative.
• Patients scoring 11 or above have only a 5 — 10% chance of dying or remaining vegetative.
• Intermediate scores correlate with proportional chances of recovery.

Ans. D: 3

The lowest possible GCS is 3 (deep coma or death), while the highest is 15 (fully awake person).

Best eye response (E)

There are 4 grades starting with the most severe:

– No eye opening

Eye opening in response to pain. (Patient responds to pressure on the patient’s fingernail bed; if this does not elicit a response, supraorbital and sternal pressure or rub may be used.)

– Eye opening to speech. (Not to be confused with an awaking of a sleeping person; such patients receive a score of 4, not 3.)

– Eyes opening spontaneously

Best verbal response (V)

There are 5 grades starting with the most severe:

– No verbal response

– Incomprehensible sounds. (Moaning but no words.)

Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange)

– Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)

– Oriented. (Patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month, etc.)

Best motor response (M)

There are 6 grades starting with the most severe:

– No motor response

– Extension to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, extension of wrist, decerebrate response)

Abnormal flexion to pain (adduction of arm, internal rotation of shoulder, pronation of forearm, flexion of wrist, decorticate response)

– Flexion/ Withdrawal to pain (flexion of elbow, supination of forearm, flexion of wrist when supra-orbital pressure applied ; pulls part of body away when nailbed pinched)

– Localizes to pain. (Purposeful movements towards painful stimuli; e.g., hand crosses mid-line and gets above clavicle when supra-orbital pressure applied.)

– Obeys commands. (The patient does simple things as asked.)

Interpretation

Individual elements as well as the sum of the score are important. Hence; the score is expressed in the form “GCS 9 = E2 V4 M3

Severity of head injury:

• Severe: GCS 3-8
• Moderate: GCS 9 – 13
• Mild head injury: GCS 14-15 with loss of consciousness (LOC)
• Minor: GCS 15 with no LOC

The GCS has limited applicability to children, especially below the age of 36 months (where the verbal performance of even a healthy child would be expected to be poor). Consequently the Paediatric Glasgow Coma Scale, a separate yet closely related scale, was developed for assessing younger children.

Ans. B: 14/ 15 with loss of consciousness

GCS in mild head injury: 14 or 15 with loss of consciousness