Re: Help with a GCS question... Originally Posted by clmsngrl82 
Basically we have a pt coming by helicopter who was involved in a single-car MVA. Something ignited in the passangers seat and the pt was burned. He has a GCS score of 8 at the scene. He was intubated and is being ventilated. HR-120, BP-80 systolic. He has bleeding from an open perineal wound where he experienced blunt trauma from the hydraulic cylinder. EMS reports he has femoral pulses, but no radial. He is cool, pale, and diaphoretic. There is blood coming from under the pts pelvic area. His pre-burn weight is 160.
Question: Discuss the GCS of 8 and the meaning/implications on this score.
I know what the scale is and I have the scale in front of me but I am having trouble being specific with this question...please help!
My guess would be that he was:
2 -- opens eyes to pain
2 -- incomprehensible words (screaming a lot)
4 -- withdrawel from pain
Essentially he is in a lot of pain from the burns, bleeding leads to shock (low bp) no radial pulse from low bp (good yardstick when unable to get bp if you got a radial it is usually 80 or greater, femoral is 70 or greater).
He could have been intubated for burns to the neck causing swelling and obstructing airway or tachypnea (elevated respiratory rate) and they thought he would poop out. Although you can intubate for GCS less than 8 you don't have to. I responded to a MRT today with a GCS of 3 - heavily oversedated, pt did not move at all to any stimuli. Couple of narcan and romizacon later and we were up to 13.
Hope this helps
Pat
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