No Coma,No Glasgow - page 3

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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... Read More

  1. by Dplear
    Aug 26, '02
    Occupation: Registered Nurse Joined: Nov '00; Posts: 900; Likes: 35
    Ohbet
    Let me pose a question for you about that person that comes in for a brokern lag rehab. say that he is a "walkie talkie" and doing fine. An agency nurse or a float nurse comes in or even a doc covering for the primary doc comes in and see's the pt now possibly gorked out ( ar eal possibility esp if he throws a clot with a broken leg...) How are they to know if this is his base line or not if it is not docunebted on ADNISSION what his base line was at that time. You run a very real possibility that he may be mistreated or diagnosed. chew on that for a bit and hopefully we can change your mind about the glasgow coma scale.

    Dave
  2. by ohbet
    Aug 26, '02
    Joined: Jun '01; Posts: 430
    OK fine, I'll just give the test.Every one is getting this test,it doesnt matter who they are,how they present, what the history or how intact they are are cognitively,everone is getting it,no matter what.If I do a history and there is no alcohol,no epilepsy,no insulin use,no druge use ,no metabolic causes, no trauma,no infection, no psychiatric causes and no stroke or other cardiovascular causes,it doesnt matter ,they get it the GCS,as if I dont have enough to do.
    As a matter of fact ,the first thing I do when I get to work this morning is Im going to sit my Head Nurse down and administer the test to her,then I think Ill give it to the DON,then the eve shift nurses,then the CNAs then the..........
  3. by JMP
    Aug 26, '02
    Occupation: RN, ICU Joined: Feb '01; Posts: 740; Likes: 2
    Ohbet

    GCS has the word "coma" in it....... Ok .....lets talk turkey here.

    The GCS was originally developed to assist general communication concerning the severity of neurologic injury.

    Some points to keep in mind, it provides data about LOC ONLY AND MUST NEVER BE considered a complete nerologic assessment. IT IS NOT sensitive to lateralization, in other words, decreasing motor response ONLY ON ONE SIDE or unilateral changes in pupils.

    Whatever tool you use, it should be one that can pick up decreasing sublte changes in LOC, such as pervious ORIENTATION TO TIME PLACE AND PERSON. PLEASE NOTE: assessment of pt's ability to follow commands is one of the highest levels of functioning evaluated. "show me your thumb" is a good one. Common mistakes people make is to say " Oh BOb, your Mom is here, show her how well you are doing.... come on BOB show her your thumb....... like you did before". It is called sensory overload.

    Using the GSC on the floor, I feel is still dumb.

    Wendy: I find myself doing neuro vitals in the ICU on head injuries, like traumas....... bleeds. It can be done on a flow sheet, if neuro vitals are ordered q4, for example. However, we do a head to toe assessment....so, LOC would be done as part of the CNS evaulation. Many of our pts are heavily sedated, propofol, midaz, fentanyl, etc. So the sedation drugs must be mentioned in your assessment as well. ALL OF OUR pts are intubated, so the GCS is no good....... and does not really mean much in this setting. It is meant to be used in a ER or EMS setting to evaulate pts LOC.
    THe best measure of LOC in most locations, including ICU is the pts ability to move all 4 limbs, grip hands and wiggle toes......in other words.......following simple commands.
    Last edit by JMP on Aug 26, '02
  4. by ohbet
    Aug 26, '02
    Joined: Jun '01; Posts: 430
    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.
  5. by hapeewendy
    Aug 26, '02
    Joined: Dec '01; Posts: 2,865; Likes: 15
    I'm done commenting on this one....
    we all have differing views on the subject
    and I for one would like to agree to disagree
    its not that I for one am not "paying attention" to what anyone else is posting.
    I read what you all type and then I give my input
    it seems like this is a major major sore spot with you just from your responses so I would suggest bringing it up to your Nurse manager or director of nursing practice , maybe they can help change the policy or explain to you why it is part of each admission .
    Many times an incident happens that spins the wheels of change into motion, maybe there was a method to their madness in including this ...
    maybe there wasnt, either way we can sit here and debate the GCS and its purpose and its name til we all turn blue and need intubation
    but the point remains we all have different ideas on what constitutes good nursing practice and what doesnt.......
    you have your seemingly strong beliefs on this one so I thin its a perfect opportunity to try to get to the bottom of the rationale for why the GCS is part of an admission at your facility.....
    many season and experienced nurses have brought opinions to the table on this one, I dont think any of them were wrong in supporting the use of the GCS....
  6. by CEN35
    Aug 26, '02
    Occupation: RN Specialty: ER, PACU, OR ; Joined: Dec '98; Posts: 2,120; Likes: 28
    ok why do it on a perfectly normal patient?

    saunders,encyclopedia and dictionary of medicine , nursing and allied health has to say about the purpose of the test ,glasgow coma scale: "a standardized system for assessing response to stimuli in a neurologically impaired patient."

    doing it shows, there was no neuro impairment. sometimes you don't do things to prove there is a problem, but rather there was not.

    besides working in the er the last six years, i can't tell you how many times some patients have come in fine, and then had some neuro s/sx. using the gcs showed approximately when the problem occured. at that point, i went into a complete neuro exam to check out all the cranial nerves. in the er, you never know for sure why they are there for while. better safe than sorry!

    me


  7. by JMP
    Aug 27, '02
    Occupation: RN, ICU Joined: Feb '01; Posts: 740; Likes: 2
    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.
  8. by CEN35
    Aug 27, '02
    Occupation: RN Specialty: ER, PACU, OR ; Joined: Dec '98; Posts: 2,120; Likes: 28
    right on jmp! :d

    me
  9. by ohbet
    Aug 27, '02
    Joined: Jun '01; Posts: 430
    Dplear,they will know his baseline because on the admission assessment,Before the part on the admission assessment that has the blasted GCS,there is a question whether the patient is alert? and then a question weather he is oriented and to what is the patient orie;nted to?,person? place? time? All?. If he is alert and Ox3,forget the GCS,and youve got your baseline
  10. by pebbles
    Aug 27, '02
    Joined: Jan '02; Posts: 562; Likes: 128
    Our Neuro assessment flowsheets show assesments in several categories.
    Top of sheet is the GCS rating.
    Below that is pupil size and response to light, left and right.
    Then the vitals, including MAP.
    Then limb response and strength, left and right, upper and lower extrmities - check off whether limb movement spontaneous, in response to pain, ect, flaccid or spastic.

    This flowsheet is a vital assessment tool that is used in all areas of the hospital when we are concerned about the neurological status of a patient. GCS is very important, for many reasons that have been previously stated in this thread. But it won't tell the whole story. Equally important are the nurse's narrative notes about the patients behaviour and responses to stimuli, etc.
  11. by chrisrob
    Aug 31, '02
    Occupation: occ health nurse Joined: Mar '02; Posts: 181; Likes: 19
    as a Glaswegian i have to say we use the coma scale on neuro pts paramedics routinly use it on pick up on everyone gives us a base line but on a walkie talkie no chance its a wasted paper exercise its not routine paperwork on all our pts or floors take it for what it is its a coma scale if you thimk theres a neuro problem use it it can and does save lives but in a vented pts whats the point umless their lightening up used right it does a good job most nurses assess neuro state when admitiing anyway meybe they just dont realise it
  12. by LatteGuzzler
    Aug 31, '02
    Occupation: ER staff nurse Specialty: 30 year(s) of experience in ER, amb surg, home health ; Joined: Aug '02; Posts: 25; Likes: 19
    The Glasgow Coma Scale is:
    a. An invention by Irish night-shift nurses designed to rate the ability to stay awake during semi-annual credentialling inservices.
    b. Stryker's newest gurney designed to weigh the unconscious during ER transport
    c. The best gosh-darn assessment tool in head injured patients.

    Yea! You got it right!:roll
  13. by MPHkatie
    Sep 1, '02
    Occupation: RN.... Joined: Apr '02; Posts: 255; Likes: 6
    a person can score a 15 on the GCS, meaning no impariment, so obviously it makes sense to do it, because if a person scores 15 one hour and a few hours later they suddenly start in with perseveration, you know that 3 hours ago when you saw that pt he was not perseverating. Sounds like you are essentially doing most of the GCS with the other questions regarding orientation and such, so perhaps its the double charting that is the problem.

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