Glasgow Coma Scale / GCS

Glasgow Coma Scale (CGS)

• Used in acute situations to assess patients
Level of consciousness
• Need to record initial examination results
Accurately
• This is only achieved using the same
Questions each time patient is assessed!
• Treatment decision may depend on whether
Subsequent examinations show improvement/
Deterioration
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Components of the GCS
There are three components to the GCS:
• Best eye opening
• Best motor response
• Best verbal response
Each is evaluated independently of the other two
Components.
ALWAYS SCORE THE BEST RESPONSE FOR
THE PATIENT
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Best Eye Opening (4 – 1)
• Assessment of eye opening shows that arousal
mechanisms located in the brain stem are
functioning.
• If patients have their eyes closed, their state of
arousal can be assessed by the degree of
stimulation needed to get them to open their
eyes.
2
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Eye Opening Response
4 = eyes open spontaneously when a person
approaches the bedside. Indicates intact
arousal mechanism.
3 = eyes open to either spoken or shouted verbal
stimulation.
2 = eyes open to a painful stimuli (to be used only
when it is clear patient will not open eyes to
verbal stimuli).
1 = failure to open eyes regardless of stimuli.
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Eye Opening
• If there is damage to the occulomotor nerve
from trauma, the patient may not be physically
able to open his or her eye.
• The occulomotor nerve is responsible for
movement of the eyelid and causes the eye to
open.
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Best Motor Response (6 – 1)
• Obeys commands (6)
• Localises to pain (5)
• Withdraws from pain (4)
• Abnormal flexion (3)
• Extension (2)
• No response (1)
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Obeys Commands (6)
• Patients are aware of their environment, have
understood the observer's instructions, and are
able to carry them out.
• Examples of possible commands are 'lift up your
arms' or 'hold up your thumb'.
• If patients are asked to 'squeeze my hands', they
must also be asked to release their grip.
3
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Localises to Pain (5)
• This is a response to a central painful stimulus.
• It involves the higher centres of the brain, the
cerebral hemispheres or cerebrum.
• It tells the body to do something about removing
the source of the pain - usually a motor response
such as moving an arm towards the source of
the pain in order to remove it and stop the pain
from continuing.
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Withdraws from pain (4)
• Patients flex or bend their arm towards the
source of the pain, but do not actually localise or
try to remove the source of the pain.
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Abnormal Flexion (3)

• Patients flex or bend the arm at the elbow and
rotate the wrist, resulting in a spastic posture in
response to a central painful stimulus.
• It is an abnormal response and indicates
severe cerebral damage and an interruption of
nerve pathways from the brain's cortex to the
spine.
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Abnormal Flexion
4
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Extension (2)

• In response to a central painful stimulus,
patients will extend or straighten an arm at
the elbow, or may rotate the arm inwards.
• Abnormal response and emanates from the
brain stem.
• It shows that patients are not able to send
information to and from the cerebrum due to
damage to the brain stem.
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Extension
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Best Verbal Response (5 - 1)
• Verbal response assesses consciousness by
determining whether a person is aware of
him/herself and the environment.
• It involves the second aspect of
consciousness - cognition.
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Orientation
There are six specific questions in the original
GCS
• What is your name
• Where are you
• Why are you here
• What month are we in?
• What year are we in?
• What season are we in?
5
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Confusion (4)
• A patient may be able to hold a conversation
with the observer but responses are
inappropriate or disoriented.
• This category is sometimes referred to as
'sentences', which is a more specific
assessment used by neurocentres.
• A patient who talks in sentences, is confused
but not orientated, and will score four.
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Inappropriate Speech (3)
• Does not carry on conversation, poor attention
span, uses inappropriate words and phrases.
• Random/confused/repetitive.
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Incomprehensible Speech (2)
• Patients are less aware of their environment
and their verbal response is in the form of
incomprehensible sounds.
• Moan or cry, unable to articulate.
• The observer may now have to use both a
painful and verbal stimulus to get a response.
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Levels of Consciousness
• GCS ratings correlate with brainstem and higher
cortical functioning:
• GCS 13 - 15: mild traumatic brain injury
• GCS 9 -12: moderate traumatic brain injury
• GCS 3 – 8: severe traumatic brain injury

Glasgow Coma Scale / GCS

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