Glasgow Coma Scale - page 2

by gwenith

The Glasgow Coma Scale has been used successfully for a number of years now BUT it has it's limitations. I find it especially limited with the non-verbal or ventilated patient. It is frustrating because you are getting... Read More


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    My best head shaker was the pupils. There was an argument - do you take the size of the pupils from before or AFTER you check for reaction. The answer of course is before referenced this to several texts and made up a learning package for the wards -guess?

    Some twerp of a ND nurse insisted on switching on the overhead lights in the patient bays in the middle of the night so that the pupil size would be accurate
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    Quote from NeuroICURN
    Thanks...I loved that avatar too! God I hope it works out that Kerry is elected on Tuesday....I honestly can't imagine another 4 years of Bush. It's really bad, and I can't understand how people can't see how he's REALLY messed things up for us. But I digress......
    I'm really beginning to think you and I were separated at birth :chuckle

    I love your avatar! Hopefully it will come true tomorrow....

    Back on topic, I've gotten some hilarious reports from OSHs and even our own ED - claiming blown pupils and a GCS< 7 on patients that turn out to be A&O. I guess as neuro nurses, we take for granted that we utilize the GCS hourly and have a much greater in depth understanding than our non-neuro peers.
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    In our hospital we don't utilize a modified Glasgow Coma Scale for our peds patients, although we really should. I think there are a bunch of changes to our charting coming down the pike though, and that wouldn't be a bad thing. Our practice with intubated patients is to score them on 10, only motor and eye opening. Not totally helpful, but.. I always include assessment data that doesn't fit into the round holes in my narrative notes, and I also make a point of reporting anything like that during rounds/report. It's frustrating to have to try and mold peds patients into the adult assessment scale, particularly kids with developmental issues. A while back I admitted a six year old who had fallen on some concrete steps. He was sent to PICU at 0130 because he had a GCS of 9-11 in ER, consistently scoring 1 for verbal. When I assessed him, I asked him if his head hurt and got an emphatic nod. I asked him if he was scared and he nodded again. Then I asked him if his name was Bobby (it wasn't) and he shook his head emphatically NO. I gave him 15/15. Then his foster mom came in and revealed that he had a speech disorder and communicated mostly with gestures. The GCS is just too limited, I think.
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    Quote from janfrn
    In our hospital we don't utilize a modified Glasgow Coma Scale for our peds patients, although we really should. I think there are a bunch of changes to our charting coming down the pike though, and that wouldn't be a bad thing. Our practice with intubated patients is to score them on 10, only motor and eye opening. Not totally helpful, but.. I always include assessment data that doesn't fit into the round holes in my narrative notes, and I also make a point of reporting anything like that during rounds/report. It's frustrating to have to try and mold peds patients into the adult assessment scale, particularly kids with developmental issues. A while back I admitted a six year old who had fallen on some concrete steps. He was sent to PICU at 0130 because he had a GCS of 9-11 in ER, consistently scoring 1 for verbal. When I assessed him, I asked him if his head hurt and got an emphatic nod. I asked him if he was scared and he nodded again. Then I asked him if his name was Bobby (it wasn't) and he shook his head emphatically NO. I gave him 15/15. Then his foster mom came in and revealed that he had a speech disorder and communicated mostly with gestures. The GCS is just too limited, I think.
    Yes, I think it would be very difficult to apply the GCS to a child. Thanks for adding your input here. More power to you for being able to work with kids!
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    Utilizing the Glasgow coma scale can be frustrating at times. The total no. scale can vary if the pt is on Ventilator. My facility using "T" for verbal when pt on ventilator and the total score is not involved with assesment of possible outcome. I find it particularly frustrating when I care for a post-resuscitated patient: example is a pt that has flaccid extremeties but can move head away to avoid oral care and beginning to open eyes. This Pt does not follow commands. I have been scoring motor as a "1" since limb movement does not occur, but with hesitation since the pt is moving her head to avoid a stimulus. I have been carrying a card I made for a different coma scale: "FOUR score " measurement. I obtained this inormation from a Nursing Spectrum article , 2006 FALL CRITICAL CARE SPECIALTY GUIDE (www.nursingspectrum.com). The source for this artical is Annals of Neurology, 2005;2005;58(4);585-593. It utilizes a score of 4 possible points or "0" score for 4 parameters: eye response, motor response, brainstem activity and respiration. I carry this card because I'm hoping someday to have a better assessment criteria in place. It takes into consideration activities such as eye tracking, and respiratory status (apnea, breathes above the vent, not intubated, etc.).
    My question: should the patients motor score be "1" since limbs do not move or higher since she moves her head to avoid oral care?


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