Glasgow Coma Scale: Difference between revisions
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The '''Glasgow Coma Scale''' (GCS) is a neurological assessment scale which aims to give a reliable, objective way of quantifying level of consciouness following a traumtic brain injury. [http://en.wikipedia.org/wiki/Glasgow_Coma_Scale] | The '''Glasgow Coma Scale''' (GCS) is a neurological assessment scale which aims to give a reliable, objective way of quantifying level of consciouness following a traumtic brain injury. [http://en.wikipedia.org/wiki/Glasgow_Coma_Scale] | ||
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 [[MOST]] assessment score for Medicine Program. | ||
== Instructions == | |||
Select the '''best''' Eye, Motor or Verbal response in the '''first 24''' hours after admission to '''ICU''' from the dropdown lists on your PDA and in Access. | |||
For reference only: | |||
{| class="wikitable" border=1 <hiddentext> set to 0 for no borders</hiddentext> | {| class="wikitable" border=1 <hiddentext> set to 0 for no borders</hiddentext> | ||
| Line 19: | Line 18: | ||
|- align="center" valign="top" | |- align="center" valign="top" | ||
|style="background-color:#CCCCE6" width="125" height="27" | | |style="background-color:#CCCCE6" width="125" height="27" | '''EYE''' Response | ||
| width="64" | | | width="64" | | ||
| width="58" | | | width="58" | | ||
| Line 32: | Line 31: | ||
|- align="center" valign="top" | |- align="center" valign="top" | ||
|style="background-color:#CCCCE6" height="39" | | |style="background-color:#CCCCE6" height="39" | '''MOTOR''' Response | ||
| Obeys | | Obeys | ||
| Line 51: | Line 50: | ||
|- align="center" valign="top" | |- align="center" valign="top" | ||
|style="background-color:#CCCCE6" height="38" | | |style="background-color:#CCCCE6" height="38" | '''VERBAL''' Response | ||
| | | | ||
| Oriented | | Oriented | ||
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|- align="center" valign="top" | |- align="center" valign="top" | ||
|style="background-color:#CCCCE6" height="38" | | |style="background-color:#CCCCE6" height="38" | '''VERBAL''' Response -'''Ventilated''' | ||
| width="48" | | | width="48" | | ||
| width="48" | Appears Oriented | | width="48" | Appears Oriented | ||
| Line 76: | Line 75: | ||
== Special Cases == | == Special Cases == | ||
=== Patients with normally limited communication ability=== | |||
For patients whose ability to communicate are reduced due to '''pre-existing conditions''', score as fully functioning if they are able to function at the level that is '''normal for this patient'''. (e.g. Down's syndrome) | |||
=== Patients who cannot '''speak''' but are communicating === | |||
Patients who are '''aphasic''' or '''intubated''' but clearly can communicate in '''writing''' should be coded as functioning normally for Verbal assessment. | |||
=== Sedated or Paralyzed Patients === | |||
For non-neuro and post operative patients who are sedated or paralyzed, record a '''normal'' GCS score unless there are concerns in regards brain injury. Sedation does not allow us to accurately assess neuological status therefore we use alternative information that was documented prior to OR or sedation or we use our "best guess" based on chart notes. | |||
====Discussion==== | |||
* I think that one might weave back and forth too much and be a bit hard to read. How about this: | |||
Being sedated or paralyzed may not allow us to accurately assess neurological status. For '''sedated''' or '''paralyzed''' patients consider their likely neurological status prior to sedation or paralysis or status when sedation wears off. | Being sedated or paralyzed may not allow us to accurately assess neurological status. For '''sedated''' or '''paralyzed''' patients consider their likely neurological status prior to sedation or paralysis or status when sedation wears off. | ||
* when using information that was '''documented prior to sedation/paralysis''' or POST OP use "best guess" based on chart notes. | * when using information that was '''documented prior to sedation/paralysis''' or POST OP use "best guess" based on chart notes. | ||
* Even if my version is not adopted, we do need to state how to score in case of brain injury. [[User:Ttenbergen|Ttenbergen]] 17:15, 18 June 2008 (CDT)Use GSC to assess brain injury. | |||
* This was touched upon in the [[:Category:Critical Care Review Group]]. [[User:Ttenbergen|Ttenbergen]] 14:08, 16 October 2008 (CDT) | |||
{{Discussion}} | {{Discussion}} | ||
| Line 102: | Line 106: | ||
[[Category: Data Collection Guide]] | [[Category: Data Collection Guide]] | ||
[[Category:APACHE II]] | [[Category:APACHE II]] | ||
[[Category:Critical Care Review Group]] | |||
Revision as of 13:08, 16 October 2008
The Glasgow Coma Scale (GCS) is a neurological assessment scale which aims to give a reliable, objective way of quantifying level of consciouness following a traumtic brain injury. [1] The Glasgow Coma Score is also used as part of the APACHE II assessment score for Critical Care Program and the MOST assessment score for Medicine Program.
Instructions
Select the best Eye, Motor or Verbal response in the first 24 hours after admission to ICU from the dropdown lists on your PDA and in Access.
For reference only:
| Score | 6 | 5 | 4 | 3 | 2 | 1 |
| EYE Response | Spontaneous | To
Speech |
To
Pain |
None | ||
| MOTOR Response | Obeys
Command |
Localizes
Pain |
Withdraws
to Pain |
Abnormal
Flexion |
Abnormal
Extension |
None |
| VERBAL Response | Oriented | Confused | Inappropriate
words |
Incomprehensible
sounds |
None | |
| VERBAL Response -Ventilated | Appears Oriented | ? Oriented | No response |
Special Cases
Patients with normally limited communication ability
For patients whose ability to communicate are reduced due to pre-existing conditions, score as fully functioning if they are able to function at the level that is normal for this patient. (e.g. Down's syndrome)
Patients who cannot speak but are communicating
Patients who are aphasic or intubated but clearly can communicate in writing should be coded as functioning normally for Verbal assessment.
Sedated or Paralyzed Patients
For non-neuro and post operative patients who are sedated or paralyzed, record a 'normal GCS score unless there are concerns in regards brain injury. Sedation does not allow us to accurately assess neuological status therefore we use alternative information that was documented prior to OR or sedation or we use our "best guess" based on chart notes.
Discussion
- I think that one might weave back and forth too much and be a bit hard to read. How about this:
Being sedated or paralyzed may not allow us to accurately assess neurological status. For sedated or paralyzed patients consider their likely neurological status prior to sedation or paralysis or status when sedation wears off.
- when using information that was documented prior to sedation/paralysis or POST OP use "best guess" based on chart notes.
- Even if my version is not adopted, we do need to state how to score in case of brain injury. Ttenbergen 17:15, 18 June 2008 (CDT)Use GSC to assess brain injury.
- This was touched upon in the Category:Critical Care Review Group. Ttenbergen 14:08, 16 October 2008 (CDT)
Discussion
- proper entry required in "special cases" for (there is a case of patients LOC reduced due to meds and how that should be coded normal as well - details anyone?) Ttenbergen 14:14, 18 June 2008 (CDT)
- How do we classify drug overdoses,when the outcome isn't clear?