I work at a commercial ambulance company that does both inter facility transports and 911s. For IFTs, we are required to submit a GCS rating. As you know, GCS measures a patient's best eye opening, verbal, and motor responses.
How would I rate a patient's best verbal response who has confused conversation at baseline due to dementia? Her best verbal response would be confused conversation, but would you rate that a 5 because she's at baseline, or a 4 because it is confused conversation? Also how would I rate the GCS of a dementia patient who is "more confused than usual"?
How would I document this?
I had an interesting patient while on call the other day that I was hoping to get some input on:
50s male found down at bottom of concrete staircase for unknown time. Awake but "disoriented" per report w finding of abrasion on R temple. Activated as type1 trauma. Overall the activation was straightforward but there was some argument over his GCS. The patient had eyes open and looked around the room somewhat aimlessly. Would not respond to verbal commands and would not speak at all. He basically looked through me when I was assessing him as if he couldn't see me at all. During the exposure portion of our activation the patient worked fairly vigorously to keep himself modest by pulling blankets over himself. He had absolutely zero response to pain. Toe clamping and a sternal rub that nearly took skin were completely ignored and he continued staring and pulling blankets up to cover himself.
I gave him a 4 for eyes, 1 for verbal, and 6 for motor since his movements were purposeful and spontaneous. There were some that argued for a 5, and a couple votes for a 4 despite his total lack of response to pain. Technically he didn't follow commands but he also didn't localize pain, withdraw from pain, flex, or extend to it... Technically.
We eventually assumed he was post ictal based on MRI and the scalp abrasion was likely a red herring sustained during a primary seizure event. He started recovering gradually over the night.
Any thoughts from meddit on how this guy should be scored in a trauma?
Long story short, my wife's aunt is a quadriplegic and she was rushed to the hospital unresponsive this morning. Since we live 2,000 miles away, the only communication we have is with my non-tech savvy mother in law. She's telling us the doctors said she's in a "3T Glasgow Coma." Can someone please let me know exactly what this means?
GLASGOW COMA SCALE The Glasgow Coma Scale is a 15-point scale. It is used for estimating and categorizing the outcomes of brain injury on the basis of overall social capability or dependence on others. This test measures the Motor response, Verbal response & Eye-opening responses: I. Motor Response 6 β Obeys commands fully 5 β Localizes to noxious stimuli 4 β Withdraws from noxious stimuli 3 β Abnormal flexion, i.e. decorticate posturing 2 β Extensor response, i.e. decerebrate posturing 1 β No response II. Verbal Response 5 β Alert and Oriented 4 β Confused, yet coherent, speech 3 β Inappropriate words and jumbled phrases consisting of words 2 β Incomprehensible sounds 1 β No sounds III. Eye Opening 4 β Spontaneous eye opening 3 β Eyes open to speech 2 β Eyes open to pain 1 β No eye opening The final score is based on the collective total of all three Categories i.e. I+II=III. With maximum score being 15 The total score obtained from this scale helps medical practitioners categorize the four possible levels for survival, with a lower the number, more severe the injury & a poorer prognosis: I) Mild Disability (13-15): II) Moderate Disability (9-12): ο§ Loss of consciousness greater than 30 minutes ο§ Physical or cognitive impairments which may or may not resolve ο§ Benefit from Rehabilitation III) Severe Disability (3-8): ο§ Coma: unconscious state. No meaningful response, no voluntary activities IV) Vegetative State (Less Than 3): ο§ Sleep wake cycles ο§ Arousal, but no interaction with environment ο§ No localized response to pain Persistent Vegetative State: ο§ Vegetative state lasting longer than one month Brain Death: ο§ No brain functions ο§ Specific criteria needed for making this diagnosis
REFERENCE: http://www.traumaticbraininjury.com/symptoms-of-tbi/glasgow-coma-scale/
