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Glasgow Coma Scale: Difference between revisions

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The '''Glasgow Coma Scale''' (GCS) [http://www.brainline.org/content/2010/10/what-is-the-glasgow-coma-scale.html] or [http://simple.wikipedia.org/wiki/Glasgow_Coma_Scale] is a the most commmon neurological assessment scale used to quantify the level of consciousness in a person following a '''traumatic brain injury'''. Basically, it is used to help gauge the severity of an acute brain injury.  
<onlyinclude>The '''Glasgow Coma Scale''' (GCS) ([http://www.brainline.org/content/2010/10/what-is-the-glasgow-coma-scale.html], [https://en.wikipedia.org/wiki/Glasgow_Coma_Scale]) is a commmon neurological assessment scale used to quantify the level of consciousness in a person following a '''traumatic brain injury'''. </onlyinclude> Basically, it is used to help gauge the severity of an acute brain injury.  


*The '''Glasgow Coma Score''' is also used as part of the [[:Category:APACHE II|APACHE II]] assessment score for Critical Care Program and the [[MOST]] assessment score for Medicine Program.  
* The '''Glasgow Coma Score''' is also used as part of the [[:Category:APACHE II|APACHE II]] assessment score for Critical Care Program and the [[ALERT Scale]] for Medicine Program.  
*The '''bedside nurses''' doing the GCS evaluation on the patient will record the best response. The '''data collector''' will look at the first 24 hours of GCS scores and record the '''worst''' value of those. 
* The '''bedside nurses''' doing the GCS evaluation on the patient will record the best response.  
==Special notes regarding sedated patients: ==
* The '''data collector''' will enter the GCS as per [[Selection and timing of APACHE components]]
*1. If a pt is an overdose, use the worst score because the sedative effect and the potential injury to the brain due to the drug overdose is part of the acuity score.
*2. If a pt is heavily sedated, a GCS is not considered accurate, therefore, if possible, use the worst GCS done when the pt. is '''not''' on sedation in the first 24 hours.
*3. If a non-sedated GCS is unavailable in the first 24 hours, use the previous un-sedated GCS if possible. 
*4. If there is absolutely no un-sedated GCS available, default to a normal GCS.
 
These instructions were given by Dr Garland utilizing the APACHE manual created by APACHE Medical Systems. --[[User:LKolesar|LKolesar]] 09:02, 2013 January 16 (EST)


== Special Cases ==
== Special Cases ==
The below are only meant to help you '''use your judgement''' keeping in mind that the purpose of the GCS is to assess the severity of a '''brain injury''', within the first 24hrs of admission.  
The below are only meant to help you '''use your judgement''' keeping in mind that the purpose of the GCS is to assess the severity of a '''brain injury''', within the first 24hrs of admission.  
===Sedated patients ===
<!-- These instructions were given by Dr Garland utilizing the APACHE manual created by APACHE Medical Systems. --[[User:LKolesar|LKolesar]] 09:02, 2013 January 16 (EST) -->
# If a pt is an overdose, use the worst score because the sedative effect and the potential injury to the brain due to the drug overdose is part of the acuity score.
# If a pt is heavily sedated, a GCS is not considered accurate, therefore, if possible, use the worst GCS done when the pt. is '''not''' on sedation in the first 24 hours.
# If a non-sedated GCS is unavailable in the first 24 hours, use the previous un-sedated GCS if possible. 
# If there is absolutely no un-sedated GCS available (e.g. [[Lost/missing chart]]), default to a '''normal GCS'''.


=== Patients with normally limited communication ability===
=== Patients with normally limited communication ability===
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Patients who are '''aphasic''' or '''intubated''' but clearly can communicate in '''writing''' should be coded as functioning normally.  
Patients who are '''aphasic''' or '''intubated''' but clearly can communicate in '''writing''' should be coded as functioning normally.  
Same is true for patients whose eyes are swollen shut etc. [http://en.wikipedia.org/wiki/Glasgow_Coma_Scale#Interpretation]
Same is true for patients whose eyes are swollen shut etc. [http://en.wikipedia.org/wiki/Glasgow_Coma_Scale#Interpretation]
=== Medicated Patients ===
If a patient is unable to respond to GSC questions because they are medicated (e.g. sedated or paralyzed), and there is no reason to expect that their response would be impaired if they were not medicated, they can be scored to a GCS assessment immediately prior to medication if available, e.g. from the ER. If the patient is sedated and there is no documented GCS prior to sedation, you can use a GCS assessment once the sedation is reduced '''if''' it is close to the 24 hour mark. If none available then score as NORMAL.


==GSC dropdown list and scores ==
==GSC dropdown list and scores ==
=== Best Eye ===
=== Best Eye ===
* stored in the [[AP_Eye field]]:
{| class="wikitable" border=1  
{| class="wikitable" border=1  
|-  
|-  
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=== Best Motor ===
=== Best Motor ===
* stored in the [[AP_Motor field]]
{| class="wikitable" border=1  
{| class="wikitable" border=1  
|-  
|-  
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=== Best Verbal ===
=== Best Verbal ===
* stored in the [[AP_Verbal field]]
{| class="wikitable" border=1  
{| class="wikitable" border=1  
|-  
|-  
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== Implementation ==
== Implementation ==
In CCMDB:  
In CCMDB:  
* L_Log populated by lookup from [[s_GCS]]:  
* L_Log populated by lookup from [[s_GCS table]]:  
**ap_eye text(13) lookup "1 None;2 To Pain;3 To Speech;4 Spontaneous"
**ap_eye text(13) lookup "1 None;2 To Pain;3 To Speech;4 Spontaneous"
**ap_motor text(19) lookup "1 None;2 Abn. Extension;3 Abn Flexion;4 Withdraws to Pain;5 Localizes Pain;6 Obeys Commands"
**ap_motor text(19) lookup "1 None;2 Abn. Extension;3 Abn Flexion;4 Withdraws to Pain;5 Localizes Pain;6 Obeys Commands"
**ap_verbal text(26) lookup "1 Oriented+Conv;2 Disoriented+Conv;3 Inappropriate Words;4 Incomp. Sound;5 No response;6 vented-appears oriented;7 vented-? oriented;8 vented-no response"
**ap_verbal text(26) lookup "1 Oriented+Conv;2 Disoriented+Conv;3 Inappropriate Words;4 Incomp. Sound;5 No response;6 vented-appears oriented;7 vented-? oriented;8 vented-no response"
*** '''The list sorting numbers for this one are opposite to scoring'''  
*** '''The list sorting numbers for this one are opposite to scoring'''
 
On Export to TMSX:
* full text of fields is exported


== Background ==
== Background ==
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*http://www.brainline.org/content/2010/10/what-is-the-glasgow-coma-scale.html
*http://www.brainline.org/content/2010/10/what-is-the-glasgow-coma-scale.html
*From the other articles referenced,primarily [http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2874%2991639-0/abstract]  
*From the other articles referenced,primarily [http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2874%2991639-0/abstract]  
*http://www.trauma.org/archive/scores/gcs.html
*http://simple.wikipedia.org/wiki/Glasgow_Coma_Scale] OR [http://en.wikipedia.org/wiki/Glasgow_Coma_Scale regular wikepedia which is needlessly verbose]
*http://simple.wikipedia.org/wiki/Glasgow_Coma_Scale] OR [http://en.wikipedia.org/wiki/Glasgow_Coma_Scale regular wikepedia which is needlessly verbose]
*http://reference.medscape.com/calculator/glasgow-coma-scale
*http://reference.medscape.com/calculator/glasgow-coma-scale


[[Category: APACHE II Physiological Variables]]
== Related articles ==
[[Category: MOST Score Elements]]
{{Related Articles}}
[[Category:Take to Task team meeting]]
 
[[Category:APACHE II Physiological Variables]]
[[Category:ALERT Scale Elements]]
[[Category:Glasgow Coma Scale | *]]
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