Gcs

[OR2ER, BSN, RN]

ok guys..dunno if this one was asked before...i had a patient 2 days ago..came in via ems.. post ictal(unwitnessed)...hx of seizure and on dilantin(turned out he's non compliant)..pt is deaf and mute..don't know sign language but understands english(middle eastern guy).on arrival..awake and in no acute distress..gcs on scene accdg to ems was 15...i was talking/communicating with the patient through paper and pen set up...a&o x 3.md came in and assess the patient..his(md) gcs was 10/10 and said to me technically the patient can't talk.i was kinda confused myself..well..how would u assess his gcs accdg to ur experience?i asked my fellow nurses and said that gcs should be 15.haaayyy

[EricJRN, MSN, RN]

This is an example of when sometimes we forget that we're treating the patient, not a machine, monitor, or numerical scale. I understand that some documentation systems would make you enter a GCS and I'm not sure how you resolve this one. If the goal was to describe the pt's true level of responsiveness, assigning a 10 seems dumb since the lack of speech was a vocal problem and not a consciousness problem. But I guess I could see where a person would be hesitant to 'break the rules' and assign a score for speech.

If we're just talking about narrative charting though, I think it would be better to just say 'Glasgow: E-4, V-NA (mute), M-6.' By leaving it broken down like that and avoiding tallying the total score, you don't risk someone thinking that your patient was obtunded.

[grambograham]

The verbal portion of this must be left out and therefore be out of 10. Assume a patient is A/O x 3 and is mumbling answers, but can write them down. GCS would not be 15. Verbal means Verbal. If the patient cannot verbalize, eg. dumb, or intubated, the 5 points are excluded and a "T" takes it's place.

[magicman]

The verbal portion of this must be left out and therefore be out of 10. Assume a patient is A/O x 3 and is mumbling answers, but can write them down. GCS would not be 15. Verbal means Verbal. If the patient cannot verbalize, eg. dumb, or intubated, the 5 points are excluded and a "T" takes it's place.

First, I feel I must correct something here. The correct terminology is mute, not dumb. That's (dumb) an antiquated way of saying things.

AFA the GCS itself, it might need to be up to policy. Im my facility, the GCS is always based on a max score of 15, but specified to be to the PATIENT'S normal ability. Thus, in this case, the score would be 15, but with the stipulation that the patient is mute , but responds and interacts correctly.

[EricJRN, MSN, RN]

First, I feel I must correct something here. The correct terminology is mute, not dumb. That's (dumb) an antiquated way of saying things.

Keep in mind that we're a pretty diverse group here at Allnurses and that using the word 'dumb' in that context simply isn't as offensive in many countries as it is here in the US.

I agree with you about referring to hospital policy about issues with the GCS. If there is such an entity as the GCS Police, I've never seen them.