Glasgow coma scale

What it is

The Glasgow Coma Scale is a score used to assess the level of consciousness. It is built from three categories: 1) eye opening response, worth 4; 2) best verbal response, worth 5; 3) best motor response, worth 6, which is the mnemonic EVM 456. The best response gives a total score of 15, the range runs 3 to 15, a comatose client scores 8 or less, and a totally unresponsive patient scores 3. A score of 8 or less is the point at which the patient is intubated, and the scale is used in trauma, neurology and the ICU.

How it is diagnosed

Eye opening response is scored: 1) no response 1; 2) to pain 2; 3) to speech 3; 4) spontaneously 4. Best verbal response is scored: 1) no response 1; 2) incomprehensible sounds 2; 3) inappropriate words 3; 4) confused 4; and oriented to time, place, and person 5. Best motor response is scored: 1) no response 1; 2) abnormal extension, that is decerebrate, 2; 3) abnormal flexion, that is decorticate, 3; 4) flexion withdrawal from pain 4; then moves to localized pain 5, and obeys commands 6. A second table sets out the same three categories with the same steps: eye opening as no opening, pain, verbal command, spontaneous; best verbal response as no verbal response, incomprehensible sounds, inappropriate words, confused, oriented; and best motor response as no motor response, extends to pain (decerebrate), flexes to pain (decorticate), withdraw from pain, localize to pain, obeys commands. It is not the only measure of consciousness among the secondary exam findings, and it is listed there with what goes around it: the level of consciousness by the AVPU scale, the Glasgow Coma Scale in trauma, blood glucose, the pupils for small, dilated or unequal, and orientation, by asking the name, where the patient is, what time it is and what day of the week it is. Beside those go the signs of trauma, the stigma of liver disease, needle tracks and drug abuse, and then a neurological examination with meningeal signs together with cardio and respiratory examination.