Glasgow Coma Scale
Glasgow Coma Scale is use to look for mental status of a patient. It provides a rapid assessment of the level of consciousness. The scoring is divided by 3 parts, eye, motor and verbal scoring. It is evaluated by monitoring response to verbal command or painful stimulation (if the patient does not response to verbal stimulus). Painful stimulation can be elicited by few ways, for example:
- Supraorbital pressure – by pressing a thumb nail on the supraorbital groove
- Sternal rub – by pressing the knuckles over the ribs (particularly at sterna region)
- Twist fold of skin – make sure that you do not leave a bruise
| Evaluation | Score |
| Eye Opening (E) | |
| Open spontaneously with normal blinking | 4 |
| Open to voice (command) | 3 |
| Open to painful stimulation | 2 |
| Does not open eye / remain closed | 1 |
| Motor response (M) | |
| Voluntary movement and responds normally to command | 6 |
| Localizes painful stimulus – attempts to protect site of pain | 5 |
| Withdrawal of limb from painful stimulus | 4 |
| Decorticate posture – flexor reflex response to pain | 3 |
| Decerebrate posture – Extensor posturing to pain | 2 |
| No movement / response to pain | 1 |
| Verbal response (V) | |
| Appropriate and oriented | 5 |
| Confused conversation | 4 |
| Inappropriate words | 3 |
| Incomprehensible speech (or sounds) | 2 |
| No sounds | 1 |
An overall score is made by adding up all the 3 areas assessed. GCS score for patient in coma is <8 while GCS for a dead man is 3 (NOT “0”!). In moderate injury, the GCS is between 9 -12 and for minor injury is between 13 -15. For an intubated patient, the verbal evaluation is omitted and replaced by “T”. So, the highest score for intubated patient is 10T. The GCS scoring for children will be slightly different.
How to remember? (tips for medical student)
Eye response = think “four eyes”
Motor response=think 6 “cylinder motor”
Verbal response=think “Jackson 5”
Related topics:
Reference:
- Murray Longmore et al. Oxford Handbook of Clinical Medicine. Seventh Edition. 2008. Oxford University Press.
- Robert Turner and Roger Blackwood. Lecture Notes on Clinical Skills. Third Edition. 2000. Blackwell Science.
- Lorne H Blackbourne et al. Surgical Recall 3rd Edition. Lippincott Williams and Wilkins.
Tags: concious level, glascow coma scale, mental status
Technorati Tags: concious level, glascow coma scale, mental status
Very nice and useful post.I really like this article and you are given here really a wonderful information. Will be referring a lot of friends about this.I really enjoy reading your blog.Thanks a lot.Keep it up.Keep blogging.
How to remember? (tips for medical student)
Eye response = think “four eyes”
Motor response=think 6 “cylinder motor”
Verbal response=think “Jackson 5”
This is very helpful, and funny too.