Glasgow Coma Scale

Question 1

What are the components of the GSC?

Answer 1

Eye opening; verbal stimuli; motor responses.

15 point scale score assigns points based on the patients

1. best eye opening (spontaneous opening = 4 to no response = 1)
2. motor response (obeys commands = 6 to no response = 1)
3. verbal response (oriented = 5 to no response = 1)

Question 2

EYE OPENING

Answer 2

• Spontaneously 4
  
  1. Reticular activating system intact; patient may not be aware
• To verbal command 3
  
  1. Opens eyes when told to do so
• To pain 2
  
  1. Opens eyes in response to pain
• No eye opening 1
  
  1. Does not open eyes to any stimuli

Question 3

VERBAL STIMULI

Answer 3

Oriented, converses 5

1. Relatively intact CNS, aware of self and environment

Disoriented, converses 4

1. Well-articulated, organized, but disoriented

Incorrect lexical response 3

1. Random exclamatory words

Non-lexical response 2

1. Moaning, no recognizable words

No verbal response 1

1. No response or intubated

Question 4

MOTOR RESPONSE

Answer 4

MOTOR RESPONSE

• Obeys verbal commands 6: Readily moves limbs when told to
• Localizes to painful stimuli 5: Moves limb in an effort to remove painful stimuli
• Flexion withdrawal 4: Pulls away from pain in flexion
• Abnormal flexion 3: Decorticate rigidity
• Extension 2: Decerebrate rigidity
• No motor response 1: Hypotonia, flaccid—suggests loss of medullary function or concomitant spinal cord injury

Question 6

Group I Head and Neurological Injuries

Answer 6

1. Recent incident of head trauma
2. No external signs of injury
3. No neurology signs and symptoms

Treatment

1. Skull radiograph
2. 24 hour observation
3. Head release form

Question 7

Group II Head and Neurological Injuries

Answer 7

1. External signs of head trauma (Lacerations, contusion, etc.)
2. No focal neurological signs

Treatment

1. External signs of head trauma (Lacerations, contusion, etc.)
2. No focal neurological signs
3. Skull radiograph and CT 48 hour observation Neuro consultation

Question 8

Group III Head and Neurological Injuries

Answer 8

1. Disorientation or loss of consciousness
2. Focal neurological sign(s)
3. Trauma with skull fracture
4. Change in vital signs (HR, BP, Resp.)
5. Treatment/Aspects
   
   1. Stabilize patient
   2. Complete imaging
   3. Full neurological evaluation

Question 9

Concussion Grade 1

Answer 9

Severity: transient confusion, no loss of consicousness, symtpoms resolve in 15 minutes

Tx: remove from activity, examine and re-examine in 5 minutes, return in 15 mintues no symptomes, rest for one week if second concussion

Question 10

Grade 2 Concussion

Answer 10

1. Transient confusion, symptsoms last for more than 15 minutes but no loss of consicousness
2. Remove from activity, Reexamine frequently, Full neurological exma in 24 hours, CT scan if symptoms last more than a week
3. 1 week rest if 1 concussion
4. 2 weeks rest if 2nd concussion

Question 11

Grade 3 concussion

Answer 11

any loss of consciousness (LOC)

1. ER with cervical spine stabilization
2. neurological
3. CT
4. 1 week rest if brief LOC
5. 2 week rest if prolonged LOC