Contents of the Glasgow Coma Scale.
Concept
The Coma Scale, a medical index to assess the degree of coma in patients, is most widely used today as the Glasgow Coma Scale (GCS, Glasgow Coma Scale). This index was published in 1974 by Graham Teasdale and Bryan J. Jennett, two professors of neurosurgery at the University of Glasgow. Jianxin Wang, Department of Neurosurgery, Aviation General Hospital, China Medical University
Assessment methods
The Glasgow Coma Index was assessed in three areas: eye opening response, verbal response and body movement, and the scores of the three areas were summed to form the Coma Index.
Eye opening response (E, Eye opening)
4 points: natural eye opening (spontaneous): when approaching the patient, the patient can open his eyes on his own, and the operator should not speak or touch the patient.
3 points: call will open the eyes (to speech): normal volume call patient, or high volume call, should not touch the patient.
2 points: eyes open with stimulation or pain (to pain): first tap or shake the patient, no response and then give strong stimulation, such as: stimulate the patient’s 2nd or 3rd finger with the tip of a pen, and increase the stimulation to the maximum within 10 seconds, strong stimulation to open the eyes is rated 2 points, if only frown, closed eyes, painful expression, can not be rated 2 points.
1 point: no response for stimulation (none)
C score: If the eyes cannot be opened due to eye swelling, fracture, etc., it should be indicated by “C” (closed).
Verbal response (V, Verbal response)
5 points: speech is organized (oriented): orientation ability is correct, can clearly express their name, city of residence or current location, year and month of the year.
4 points: can answer, but the answer is not the case (confused): orientation ability is impaired, there is a wrong answer.
3 points: can say single words (inappropriate words): completely unable to carry on a conversation, can only say short sentences or single words.
2 points: can make sounds (unintelligible sounds): can only make meaningless grunts in response to painful stimuli.
1 point: no response (none).
T score: unable to make normal sounds due to tracheal intubation or incision, indicated by “T” (tube).
D score: history of speech disorder, indicated by “D” (dysphasic).
M, Motor response
6 points: obey commands: 2 different actions are performed as instructed.
5 points: localize the location of pain when stimulation is applied: when a painful stimulus is given, the patient can move the limb to try to remove the stimulus. The gold standard for painful stimulation is pressure on the supraorbital nerve.
Score 4: The limb retracts (withdrawal) in response to the painful stimulus.
3: Decorticate flexion in response to painful stimuli: “decorticate tonic” posture.
2 points: decerebrate extension in response to painful stimuli: “decerebrate tonic” posture.
1 point: no response.
Determination of the degree of coma
The Glasgow Coma Scale has a maximum score of 15, indicating clear consciousness; 12-14, mildly impaired consciousness; 9-11, moderately impaired consciousness; and below 8, coma; the lower the score, the more impaired the consciousness. The lower the score, the more impaired the consciousness. The best response at the time of selection is scored. Note that the left right side of the motor score may be different, and use the higher score for scoring. Modified GCS scores should be recorded for best response/worst response and left-sided/right-sided motor scores.
Recording method
Example: GCS score 15 points (4+5+6).