No Coma,No Glasgow - page 4

[NEW] Finish the Toon Caption Contest! Win $100.

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 globalRN
    Sep 1, '02
    Occupation: RN, NP Joined: Sep '02; Posts: 479; Likes: 96
    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.
    Last edit by globalRN on Nov 17, '02
  2. by ohbet
    Sep 1, '02
    Joined: Jun '01; Posts: 430
    A and O x 3 can still be nero impaired? Well thank you,I learned something new today.
  3. by JMP
    Sep 2, '02
    Occupation: RN, ICU Joined: Feb '01; Posts: 740; Likes: 2
    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.
  4. by Vsummer1
    Sep 2, '02
    Occupation: RN, ICU/CCU Joined: Aug '02; Posts: 1,062; Likes: 7
    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
  5. by ohbet
    Sep 2, '02
    Joined: Jun '01; Posts: 430
    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
  6. by hapeewendy
    Sep 2, '02
    Joined: Dec '01; Posts: 2,865; Likes: 15
    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
  7. by kimpeccable
    Jan 23, '11
    Occupation: Institutional Nurse Joined: Jan '11; Posts: 1
    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.
  8. by ZippyGBR
    Jan 23, '11
    Occupation: Nurse Specialty: Spinal Cord injuries, Emergency+EMS ; From: UK ; Joined: Feb '07; Posts: 1,051; Likes: 523
    Quote from fedupnurse
    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
  9. by ZippyGBR
    Jan 23, '11
    Occupation: Nurse Specialty: Spinal Cord injuries, Emergency+EMS ; From: UK ; Joined: Feb '07; Posts: 1,051; Likes: 523
    Quote from ohbet
    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 ...
  10. by rn/writer
    Jan 23, '11
    Joined: Dec '04; Posts: 11,695; Likes: 14,914
    Don't want to rain on anyone's parade, but this thread is more than eight years old. The OP last posted in 2003.
  11. by ZippyGBR
    Jan 23, '11
    Occupation: Nurse Specialty: Spinal Cord injuries, Emergency+EMS ; From: UK ; Joined: Feb '07; Posts: 1,051; Likes: 523
    Quote from ohbet
    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 ?
  12. by Jonathank
    Jan 23, '11
    Joined: Aug '10; Posts: 284; Likes: 238
    Quote from ohbet
    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...
  13. by ZippyGBR
    Jan 23, '11
    Occupation: Nurse Specialty: Spinal Cord injuries, Emergency+EMS ; From: UK ; Joined: Feb '07; Posts: 1,051; Likes: 523
    Quote from JMP
    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

close