Glasgow Coma Scale in Intubated Patients
Multiple Choice Questions in Neurology:
Glasgow Coma Scale (GCS) in Tracheostomized or Intubated Patients
Glasgow Coma Scale (GCS)
- Score 4: Opens eyes spontaneously
- Score 3: Opens eyes in response to voice
- Score 2: Opens eyes in response to pain
- Score 1: Does not open eyes
- Score 5: Oriented, converses normally
- Score 4: Confused, disoriented
- Score 3: Words
- Score 2: Makes sounds
- Score 1: Makes no sounds
- Score 6: Obeys commands
- Score 5: Localizes to painful stimuli
- Score 4: Flexion / Withdrawal to painful stimuli
- Score 3: Abnormal flexion to painful stimuli (decorticate response)
- Score 2: Extension to painful stimuli (decerebrate response)
- Score 1: Makes no movements
- Severe: GCS < 8–9
- Moderate: GCS 9–12
- Minor: GCS ≥ 13
Glasgow Coma Scale in Special Situation
- Post-fix (t) is used to denote “Tube”
- Score should be “1”
- In practice, we usually avoid “1” and write only post-fix like EV(t)M. Ideally it should be EV(1t)M.
- So, maximum score in tracheostomized or intubated patient is 11 [E4V(t)M6) or E4V(1t)M6)].
- Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. The Lancet. 1974 Jul 13;304(7872):81-4.
- Teasdale G, Murray G, Parker L, Jennett B. Adding up the Glasgow coma score. InProceedings of the 6th European Congress of Neurosurgery 1979 (pp. 13-16). Springer, Vienna.
- Meredith, Wayne, et al. "The conundrum of the Glasgow Coma Scale in intubated patients: a linear regression prediction of the Glasgow verbal score from the Glasgow eye and motor scores." Journal of Trauma and Acute Care Surgery 44.5 (1998): 839-845.
Analysis of the Above Multiple Choice Questions in Neurology
- The patient was on ventilator => Patient should be intubated or tracheostomized.
- So modified Glasgow Coma Scale should be applied. Verbal response should be V(1t) or simply V(t). Score is “1”.
- The patient was able to localize painful stimulus from left side of hand => M5
- The patient was able to open eyes on painful stimulus => E2
- So, total GCS is “8”.