No Coma,No Glasgow

[ohbet]

The Glasgow Coma Scale was designed to measure the depth of Coma. This means that a person must already be in a Coma prior to the test administration.

When we have a new admit, The Glasgow is on our admission assessment and 99% nurses administer the test to people not in a coma.

I have become unpopular by pointing this out but the practice continues.

Any thoughts or similar experiences with the misuse of this test?

[rn/writer, RN]

Don't want to rain on anyone's parade, but this thread is more than eight years old. The OP last posted in 2003.

[ZippyGBR, BSN, RN]

Pay attention to what JMP is saying,the scale purpose,what it was designed originally for is to use when someone has a neuro injury, and not for the entire worlds population.

do you have pragmatic- semantic language disorder ?

[Jonathank]

Pay attention to what JMP is saying,the scale purpose,what it was designed originally for is to use when someone has a neuro injury, and not for the entire worlds population.

Didn't you say that it's your facility's policy to a GCS on every admit? Whatever it was designed for isn't as big an issue for you right now compared to what your employers want you to do with it. Follow the policy, get it changed, or move on...

[ZippyGBR, BSN, RN]

CEN

ER is one of the places GCS makes sense, In my view. Where I am in ICU, makes no sense. Out with the EMS, makes sense, of course. Up on the floors????????? That was my point. Makes no sense.

As stated in my earlier post, GCS is does not account for unilateral pupil changes, for example. Does not account for lateral changes, one side weaker than other. Most floor nurses, not all, but I would bet most have no idea what a GCS of 7 vs. 9 mean...........or am I wrong?

I just think a CNS evaulation outside of ER or EMS would be better served by stating, alert, orientated, able to follow commands. VS> CGS of 11. Just my thoughts.

you demolish your own argument by talking about a single figure GCS score... rather than evm and total ...

AVPU is used as a component of some early warning scores, but AVPU provides even less information than GCS

FAST is being advocated as an assessment tool for CVA and that provides lessinformation than GCS

a GCS score is not a total neuro assessment but that does not mean that a baseline GCS is not useful - especially given that a neurological insult can come from many causes not only trauma ...

but all of the above along with other pertinent findings are all integral parts of evaluating your patient

[ZippyGBR, BSN, RN]

A and O x 3 can still be nero impaired? Well thank you,I learned something new today.

CVA patients, people with a spinal cord injury or a neurological condition ...

[ZippyGBR, BSN, RN]

Its ludicrous to be checking pupils on a person who is alert,as fixed and dialated is a very late sign of neuo-impairment.No matter,I was taught in school to check pupils on our alert patients.

I hope someone is not going to tell me that alert and oriented patients can have fixed and dialated pupils,please God

tell me what other things can be determined from looking at a patient's pupils ...

what are the pupils like someone who is intoxicated with alcohol, what are hte pupils like with someone who has had excessive opiates ...

why might we be interested in differences between pupils in someone with a head injury or facial trauma ?

[canoehead, BSN, RN]

Is this a quiz?

It doesn't hurt anyone, including the patient, if the nurse writes GCS 15 on the chart, so why make a big deal about it?

I've started GCSing lots of people in the ER who ended up not needing that type of monitering. Just like I've written "moves 4limbs" when they weren't paraplegic- it's a baseline.

[BluegrassRN]

Old thread, people, old thread.

Interesting topic for discussion, but no need to worry about ohbet's indignation or frustration, he/she hasn't been around for years.

[netglow, ASN, RN]

Ha, just noticed that, LOL! Zippy you were totally covering the bases tho!

Seriously GCS is not even an effort, no biggie. I do an entire assessment anyway. I don't care if the facility (computer charting) wants less. Who cares I do what I want to do.