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?

[chrisrob]

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

[LatteGuzzler, BSN, RN]

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

[MPHkatie]

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.

[globalRN]

GCS is used as an assessment tool for neurological function. A

patient can be alert and oriented x 3 and still have neurological deficits which can be picked up (eg. diminished bilateral limb strength, drug overdose) which can steer your care. Depending on the presenting problem, PE /History, the GCS is a good tool for initial and continued assessment. GCS IS NOT a coma assessment tool only!

As a past BSN nursing instructor who supervised students in neuro units, it is amazing how the GCS is incorrectly applied/interpreted by many nurses.

[ohbet]

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

[JMP]

GLobal

Please re read some of my posts regarding this subject. IT appears people generally do not understand where and how the GCS is appropriate. As I have stated earlier, if somemone is unilaterally changed, example, unilateral pupil change, unilateral grip change the GCS does not pick that up,

We should not get hung up on A and O X 3......... it should be part of the larger assessment - alert, orientated X 3, grips equal, obeys commands. One of the most challenging things neuro pts can do is to obey commands, example....... show me your right thumb.

If you work or even teach in critical care, you will come to find out that in an ICU setting the GCS is totally useless.

[Vsummer1]

I just finished my first week of nursing classes, so what do I know? Our instructor told us that it is part of the assesment and to do it. We were told it is used on any patient who may have had a head injury. At this point, we are to learn it and use it for our assesment skills. She couldn't even spell it right when she wrote it on the board "glascow" (and I knew how from here so I felt so good... but didn't correct her!)

Maybe one of our dummies will fall off the bed when someone is practicing their bedmaking and we can use it then?

In any case, I learn so much from you guys! :kiss

[ohbet]

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

[hapeewendy]

ohbet

no offense my friend

but can you get over this now?

I mean okay you post to ask us about the use of the GCS , quite a few ppl respond

and then you always come back with some response about this being silly or that being ludicrous or that you "learned something new today"

when you ask for opinion you get it

whether you find it smart silly stupid or brilliant

[kimpeccable]

So what about a ventilator-assisted patient who came in due to a myocardial infarction, can I perform a Glasgow Coma Scale to him? By the way, he's drowsy and very rarely opens his eyes.

[ZippyGBR, BSN, RN]

We also use the GCS on each and every patient in our unit. Just because the word coma is in it doesn't really mean that is it's only use. As Chuck put it so well, it is really a scale to measure LOC.

GCS has grown beyond it;s original use and with most scores that have grown beyond their original use there may be issues ( thinking about the physiological obs based 'early warning scores' that were developed for use in elective surgery)

as other posters have pointed out it provides a good ready reckoner and has become an accepted standard of care internationally

[ZippyGBR, BSN, RN]

Truth is not majoritarian so Im sticking to my position.

When an admit comes in and is alert and oriented to person , place and time whats the point of using the Glasgow? Why do you think it is called a Coma scale? It measures the depth of coma. A person who is alert is not in a Coma!

how do you quantify that they are not in a coma without making reference to a an E4V5M6 GCS score ?

do you have any documentary evidence to back up your assertion that GCS should only be used on people 'in a coma' despite the fact itcan be used to chart the progress of ANY neurological insult ...