glasgow coma scale dr. s. parthasarathy md., da., dnb, md (acu), dip. diab.dca, dip. software...
TRANSCRIPT
![Page 1: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/1.jpg)
Glasgow coma scale
Dr. S. Parthasarathy MD., DA., DNB, MD (Acu),
Dip. Diab.DCA, Dip. Software statistics PhD (physio)
Mahatma gandhi medical college and research institute, puducherry, India
![Page 2: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/2.jpg)
Some history
• Teasdale and Jennett in 1974
• the Glasgow Coma Scale or GCS is a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment.
![Page 3: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/3.jpg)
First use !!
• as a method of describing states of impairment within the consciousness continuum
• a quick, practical standardized system for assessing
the degree of consciousness in the critically ill and
for predicting the duration and ultimate outcome
of coma, primarily in patients with head injuries
![Page 4: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/4.jpg)
Original authors
• Changing level of consciousness – development of complications
• Depth of coma ---for ultimate recovery which can be expected
• Assessment at 6 h following head trauma.- influence of alcohol, drugs, hypoxia gone
![Page 5: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/5.jpg)
![Page 6: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/6.jpg)
• The scale involves • eye opening, • verbal response, • and motor response, all of which are
evaluated independently according to a rank order that indicates the level of consciousness and degree of dysfunction
![Page 7: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/7.jpg)
Electronic Voting Machine
• E – 4 • V – 5 • M- 6
![Page 8: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/8.jpg)
• The sum of the numeric values for each parameter can also be used as an overall objective measurement.
• E + V + M 15 indicative of no impairment, • 3 compatible with brain death, and • 7 usually accepted as a state of coma.
![Page 9: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/9.jpg)
EVM – separate analyses
![Page 10: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/10.jpg)
![Page 11: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/11.jpg)
![Page 12: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/12.jpg)
![Page 13: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/13.jpg)
Localize
![Page 14: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/14.jpg)
Withdrawal
![Page 15: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/15.jpg)
Flexor
![Page 16: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/16.jpg)
Extensor
![Page 17: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/17.jpg)
Clinical uses
. The test score can also function as an indicator for certain diagnostic tests or treatments, such as the need for a computed tomography scan, intracranial pressure monitoring, and intubation.
The scale has a high degree of consistency even when used by staff with varied experience.
![Page 18: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/18.jpg)
Clinical uses
• The results may be plotted on a graph to provide a visual representation of the improvement, stability, or deterioration of a patient's level of consciousness, which is crucial to predicting the eventual outcome of coma.
• various medical conditions including drug overdose, infection, spontaneous intracranial
bleeding, seizures and hepatic encephalopathy
![Page 19: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/19.jpg)
v
Time
![Page 20: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/20.jpg)
Head Injury Classification
• Severe Head Injury----GCS score of 8 or less Moderate Head Injury----GCS score of 9 to 12 Mild Head Injury----GCS score of 13 to 15
![Page 21: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/21.jpg)
Clinical uses
• To facilitate understanding, clear description and communication between clinicians
• For research purposes
![Page 22: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/22.jpg)
Prognosis
• The GCS motor score 2 weeks after injury was statistically significantly associated with the 12-month functional outcome in TBI survivors.
• Motor response was the most useful predictor among the GCS components with respect to the long-term functional outcome in patients with severe TBI. -- Controversial !!
![Page 23: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/23.jpg)
In stroke !!
• The GCS verbal component may be misleading in acute stroke:
• a focal neurological deficit leading to dysphasia could affect the score, independently of level of consciousness.
![Page 24: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/24.jpg)
Which will confuse GCS ??Ocular trauma , Cranial nerve injuries , edema of
tongue Facial trauma Injuries (spinal cord, peripheral nerves, extremities)Pain , Intoxication (alcohol, drugs)Medications (anaesthetics, sedatives)Dementia , Psychiatric diseasesDevelopmental impairmentsIntubation, tracheostomy, LaryngectomyMutism Hearing impairments
![Page 25: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/25.jpg)
Detailed breakdown of GCS components
• Eyes
• GCS 0f 3- 4 – brain stem may be ok
• but 2 or less ??
• Vegetative state can have rarely spontaneous reflexive eye opening !!!
![Page 26: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/26.jpg)
Verbal
• Presence of speech implies a high level of integration in the nervous system
• Motor scores of 6, 5 and 4 imply the presence of cerebral function and the ability to react appropriately to a noxious stimulus.
• 2 or 3 – may be brainstem ??
![Page 27: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/27.jpg)
Children – verbal response
![Page 28: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/28.jpg)
Compare with other scores
![Page 29: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/29.jpg)
FOUR score
• The FOUR (Full Outline of UnResponsiveness)
score, not surprisingly, has four components,
each of which has 4 as the maximal grade.
• Eye, motor, brainstem reflexes, respiration
![Page 30: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/30.jpg)
AVPU score • The GCS was compared to the AVPU• Alert, responds to Verbal stimuli, responds to
Painful stimuli, Unresponsive score and median GCS scores of 15, 13, 8 and 3 corresponded to AVP and U respectively
• A, V, P, U 15, 13, 8, 3
![Page 31: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/31.jpg)
WFNS GCS motor deficit
• I 15 absent • II 14- 13 absent• III 14 – 13 present • IV 12 -7 present or absent• V 6 -3 present or absent
![Page 32: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/32.jpg)
Conclusions
• All the advantages • But
• Concerns have been raised about the potential for misleading levels of precision engendered by the use of the GCS,
• and the use of simpler scales suggested.
![Page 33: Glasgow coma scale Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab.DCA, Dip. Software statistics PhD (physio) Mahatma gandhi medical college and](https://reader030.vdocuments.net/reader030/viewer/2022032703/56649d1f5503460f949f3a74/html5/thumbnails/33.jpg)
• Thank you all