Glasgow Coma Scale
Micro-lecture by the Australian Paramedical College
In today’s micro-lecture, Australian Paramedical College Hon. Snr. Lecturer Sam Willis talks about how to manage the Glasgow Coma Scale.
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Glasgow Coma Scale
In today’s micro-lecture we’re going to talk about the Glasgow Coma Scale. Now Glasgow Coma Scale has been around for quite some time, and it’s not new. However, we understand that it might be new to you if you’re studying para medicine for the first time. Now the Glasgow Coma Scale is designed to help you as the paramedic assess levels of consciousness in your patients. Now some use it to determine the levels of coma, but they’re generally the same thing, unconsciousness, consciousness. Following the Glasgow Coma Scale really does make it simple and breaks it down for you.
When you arrive on scene at your patients, if you have somebody who is conscious and talking, and they’re telling you oh, I’ve got chest pains, or I’ve injured myself then it’s not a problem to say quite quickly that they got at GCS (Glasgow Coma Scale) of 15, and here’s why. The GCS (Glasgow Coma Scale) is broken down into three parts, eyes opening, best verbal response, best motor response. In this first section the top points that you can get are a 4. In the second section, which is verbal response, the best marks you can get is 5. And the best motor response the top marks you can get is 6.
If your patient approaches you and says, I’ve got pain, and their eyes are open spontaneously, and fully alert. If they are saying I’ve got chest pains then that they obviously know where they are, and therefore they’re a 5. A base command, that could be something as simple as asking them to shake your hand. Hi, my name is Sam. I’m from the ambulance service. Then you got, oh hi, I’ve got chest pains. 15 is the top score you can get using the GCS (Glasgow Coma Scale).
At the other end of the spectrum the lowest score you can get is 3. Eyes opening, there’s no response to anything. There’s no response to speech. There’s no response to pain. They’re completely unresponsive therefore, the patient gets a 1. Best verbal response, oriented to time place and person, no inappropriate words, no, there’s nothing coming out of their mouth whatsoever, 1. And motor response, there’s none of these things going on at all, so that’s a 1. The lowest is a 3. They would never get any lower than a 3.
Let’s talk about verbal response. Oriented to time place and person, so they know where they are. They’re not confused. Confusion and inappropriate words, believe it or not there is big differences. Confused means that they generally know what’s going on, but there is a little bit of confusion as to what’s going on around them, so it could be that they don’t know who you are. Occasionally they’ll say, who are you, who are you, when you’ve just been having a conversation with them. Inappropriate words is moving more towards complete confusion. In other words, the language that they’re using doesn’t make any sense to the situation. Incomprehensible sounds is more to do with groaning and moaning. Let’s say a patient’s had a nasty head injury, and they’re just going ah, ah, and they’re making a moaning noise.
Motor response, motor has to do with movements of the muscles. A base command, shakes your hand. That’s a 6. Moves to localized pain, so you give them a nice squeeze there, and they move it away. You don’t generally need to do that to a patient who is fully alert. Flexion, withdraw from pain. Now what happens is let’s say they’re semiconscious, and you just give them a squeeze they’ll go up to actually move the pain away, but they don’t actually get there. The hand just stops. Abnormal flexion is called decorticate where you have this decorticate posturing. An abnormal extension when you ask for a response, or you instigate pain, or pressure is decerebrate posturing. This is what this looks like. There you go. That’s decorticate. Now remember, somebody throws a ball to you and you decorticate the ball, you decort the ball. That’s what decorticate is. Decerebrate is where the hands are moved away. There are a lot of different things that can cause that including hypoxia and raised intracranial pressure.
So that’s a short micro lecture on the GCS (Glasgow Coma Scale).
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