Escala de Glasgow - Atualização e como utilizar.

Summary

This video provides an in-depth explanation of the Glasgow Coma Scale (GCS), including updates from 2018. The presenter explains the scale’s three main components—ocular, verbal, and motor responses—detailing how to assess patients in both pre-hospital and hospital settings. The video covers the scoring system, from a perfect score of 15 to the lowest possible score of 3, and explains key concepts like verbal confusion, motor responses, and pupil reactions. Special attention is given to the importance of knowing the GCS for healthcare professionals to properly assess and communicate patient conditions in emergency and medical scenarios.

Takeaways

• 😀 The Glasgow Coma Scale (GCS) is essential for evaluating patients' neurological status, both pre-hospital and in-hospital.
• 😀 The scale has been updated in 2018 with new research and practices, such as changes in how stimuli are applied (e.g., physical vs. painful stimuli).
• 😀 The GCS is based on three major components: ocular response, verbal response, and motor response, with the best possible score being 15.
• 😀 The patient’s best eye response is evaluated with a scale from 1 to 4, where 4 points indicate eye opening without any stimulus.
• 😀 The best verbal response ranges from 1 to 5 points, with 5 points given if the patient is fully oriented and aware of time, place, and event.
• 😀 The best motor response ranges from 1 to 6 points, with 6 points given if the patient obeys commands to move limbs.
• 😀 Glasgow scores below 8 indicate the need for intubation, as the patient may be at risk of respiratory failure.
• 😀 A Glasgow score of 3 (lowest score) indicates that the patient is unconscious and unresponsive to all stimuli.
• 😀 The newer Glasgow Coma Scale Pilar (introduced in 2018) incorporates a pupillary response to light, which can give important insights into brain function and damage.
• 😀 Decerebrate and decorticate posturing in patients with severe brain trauma are key signs that should be identified as they are indicators of severe neurological impairment.
• 😀 The GCS is crucial for communicating patient condition to the medical team, especially for patients with significant brain injury, helping to guide treatment decisions.

Q & A

What is the Glasgow Coma Scale (GCS)?

The Glasgow Coma Scale (GCS) is a neurological scale used to assess a patient's level of consciousness. It evaluates three aspects: ocular response, verbal response, and motor response, with the score ranging from 3 (lowest) to 15 (highest).

What is the minimum and maximum score on the Glasgow Coma Scale?

The minimum score on the Glasgow Coma Scale is 3, indicating no response across all categories. The maximum score is 15, indicating the best possible response in each category.

What is the significance of a Glasgow score less than 8?

A Glasgow Coma Scale score less than 8 typically indicates a severe impairment of consciousness, and in many cases, it suggests the need for intubation, although intubation is not always mandatory.

How are ocular responses evaluated in the GCS?

Ocular responses are evaluated based on how the patient reacts to stimuli. If the patient opens their eyes spontaneously, they score 4 points. If they respond to voice, they score 3 points, and if they only open their eyes in response to a physical stimulus, they score 2 points. No eye opening earns a score of 1.

What is considered a 'best verbal response' on the GCS?

A best verbal response of 5 points is given when the patient is fully oriented, able to respond appropriately to questions. A score of 3 points is given for disorganized speech, while a score of 2 points is given for incomprehensible sounds or moaning.

What does a 'best motor response' score refer to in the GCS?

The best motor response assesses how well the patient can obey commands or respond to pain. A score of 6 points is given if the patient can fully obey commands, while a score of 5 points is given if the patient moves toward pain. A score of 4 is given for localized response, and 3 points for flexion to pain.

What are the differences between decerebrate and decorticate posturing?

Decerebrate posturing involves the patient extending their arms and legs outward, often associated with severe brain injury, particularly in the brainstem. Decorticate posturing involves flexion of the arms towards the chest, and is generally considered a less severe form of brain injury.

What are the new updates to the GCS introduced in 2018?

The 2018 updates introduced the Glasgow Coma Scale for Pupillary Reflex (GCS Pupillary), which includes evaluating the pupillary response to light. It helps assess brain function, especially in patients with significant brain injuries and potential brain death.

How does the Glasgow Coma Scale for Pupillary Reflex (GCS Pupillary) differ from the original GCS?

The GCS Pupillary specifically focuses on the reaction of the pupils to light, indicating the functioning of the brain's hemispheres. The original GCS evaluates overall responsiveness through eye opening, verbal, and motor responses.

What does it mean if a patient has a Glasgow Coma Scale of 3?

A Glasgow Coma Scale score of 3 means that the patient has no eye opening, no verbal response, and no motor response, typically indicating a state of deep unconsciousness or brain death.