Glasgow Coma Scale

Question 1

What is consciousness?

Answer 1

Reflects level of arousal and presence of cortical behaviour (cerebral hemispheres)

Question 2

List some factors that effect consciousness.

Answer 2

Trauma
Elevated ICP
Fever
Hypothermia 
Seizure
Hypotension/severe hypertension
Hypoxia 
Hypercapnia 
Sepsis
Metabolic 
Medications (e.g. sedatives)

Question 3

Why was the GCS created?

Answer 3

To standardise assessment of consciousness
Can be performed by many people
- reproducible
Predicative of prognosis

Question 4

What are the three subscales of the Glasgow Coma Scale?

Answer 4

Verbal
Eyes
Motor

Question 5

What are the different eye scores a person can be given when assessing consciousness?

Answer 5

4 - spontaneous
3 - open to verbal command
2 - open to pain
1 - don’t open

Question 6

When can’t a patients eye score be assessed?

Answer 6

When they can’t open their eyes (don’t have any, swollen)

- write on the chart that their eye score can’t be assessed

Question 7

What are the different verbal scores a person can be given when assessing consciousness?

Answer 7

1 - can't talk
2 - incomprehensible sounds 
3 - inappropriate words
4 - confused 
5 - orientated to time, place and person

Question 8

When is assessing a patients verbal response difficult?

Answer 8

When they are intubated
- ‘T’ is appended to the score
When they are speaking a foreign language

Question 9

What are the different motor scores a person can be given when assessing consciousness?

Answer 9

1 - no movement 
2 - extension
3 - abnormal flexion
4 - normal flexion
5 - localises to pain
6 - obeys commands

Question 10

When is assessing a patients motor response difficult?

Answer 10

They are paralysed
- ask the to move their face
The patient has received muscle relaxants

Question 11

Describe the difference between abnormal flexion and extension postures.

Answer 11

Flexion
- patients arms a pulled into themselves
Extension
- patient arms are twisted away from their body

Question 12

What is the definition of a coma?

Answer 12

Inability to obey commands, speak or open their eyes to pain.

Question 13

What is the difference between adult and paediatric GCS?

Answer 13

You can’t assess the verbal response of children (especially under the age of 5)
- can’t talk
- if they can, don’t know the date, where they are, etc.
Babies can’t obey commands needed for motor response

Question 14

Describe a GCS best verbal response that is modified for young children.

Answer 14

1 - no verbal response
2 - restless, agitated
3 - persistently irritable
4 - consolable crying 
5 - appropriate words, smiles, fixes and follows with their eyes

Question 15

What is the validated GCS for young children?

Answer 15

There are none

• predication of outcome isn’t as reliable
• hard to reproduce

Question 16

How are head injuries classified?

Answer 16

No uniform classification 
- different head injuries can be the same GCS, but have wildly different outcomes after treatment
GCS
- minor = 14/15
- moderate = 9-13
- severe = <8

Question 17

How does GCS help predict the outcome of a patient?

Answer 17

IMPACT
- consistent association between motor score and 6-month GOS across all studies
- eye and verbal components were also strongly associated with GOS
CRASH
- GCS and 14 day mortality is linear
- GCS and 6 month poor outcome is also linear