Glasgow Coma Scale at 40 | The new approach to Glasgow Coma Scale assessment

Summary

This video provides a comprehensive guide to using the Glasgow Coma Scale (GCS) for assessing patients with acute brain injury. It explains how to evaluate eye opening, speech response, and motor movements through auditory, mechanical, and central stimulation. The script emphasizes the importance of thorough observation and systematic scoring to determine the severity of the patient's condition. Additionally, it highlights the significance of clear communication and proper documentation in clinical settings to track changes in patient status. The GCS is presented as a vital tool for professionals to make accurate assessments and decisions in critical care.

Takeaways

• 😀 The Glasgow Coma Scale (GCS) is used to assess a patient's level of consciousness, especially in cases of acute brain injury.
• 😀 The assessment evaluates three components: eye-opening, speech response, and motor response.
• 😀 The first step in the GCS assessment is a pre-check to identify factors, such as hearing impairment, that could interfere with the evaluation.
• 😀 Observation of the patient is the next step, where spontaneous actions related to eye-opening, speech, and movements are noted.
• 😀 If spontaneous responses are absent, auditory and mechanical stimuli are applied to assess the patient's reaction.
• 😀 Eye-opening is evaluated using four levels, speech response is evaluated with five levels, and motor response with six levels of possible responses.
• 😀 The best response in each component is normal, while the worst response is no reaction at all.
• 😀 For motor response, the evaluation includes checking if the patient follows commands, reacts to pain, or exhibits abnormal movements.
• 😀 Central and peripheral stimuli may be used to assess motor responses if a patient doesn't react to commands or light stimuli.
• 😀 The GCS score can be presented numerically, but it's essential to describe the patient's responses in detail alongside the numeric score for clarity.
• 😀 The GCS helps clinicians track changes in a patient's condition over time and facilitates clear communication between healthcare providers.

Q & A

What is the primary purpose of the Glasgow Coma Scale (GCS)?

The Glasgow Coma Scale (GCS) is used to assess the level of consciousness in patients with acute brain injuries by evaluating their eye opening, verbal response, and motor response to stimuli.

How many components are assessed in the Glasgow Coma Scale, and what are they?

The Glasgow Coma Scale assesses three components: eye opening (4 levels), verbal response (5 levels), and motor response (6 levels).

What should a clinician check during the 'Check' phase of the GCS evaluation?

During the 'Check' phase, clinicians should identify any factors that could interfere with the assessment, such as hearing impairments, which might affect the patient's ability to respond to stimuli.

What does a score of 'Spontaneous' for eye opening indicate?

'Spontaneous' means the patient opens their eyes without any external stimulation.

What should a clinician do if the patient does not open their eyes spontaneously?

If the patient does not open their eyes spontaneously, the clinician should use verbal stimuli (such as calling the patient’s name) and, if necessary, apply mechanical stimuli (such as applying pressure to the nail bed).

How is the verbal response assessed in the GCS?

The verbal response is assessed based on the patient's ability to answer questions correctly, their ability to speak coherent sentences, or the ability to make sounds. The responses range from 'oriented' to 'none'.

What is meant by 'Normal Flexion' in the motor response section of the GCS?

Normal Flexion refers to a patient flexing their arm at the elbow in response to pain, a normal reflex seen in conscious individuals.

What does 'Extension' in the motor response section indicate?

'Extension' indicates that the patient responds to pain by extending their limbs, which is typically a sign of severe brain injury.

How should the GCS be used to track a patient's condition over time?

The GCS should be used regularly to assess and track changes in a patient's level of consciousness, either for improvement or deterioration, which helps in guiding clinical decision-making.

What should a clinician do if a patient cannot speak due to an endotracheal tube?

If a patient cannot speak due to an endotracheal tube, the clinician should mark the verbal response section as 'Unable to assess' rather than assuming the absence of speech is due to a loss of consciousness.