No Coma,No Glasgow

cbs3143 · Aug 25, 2002

I suggest that the Glasgow Coma Scale is a monitor of level of consciousness. If you wait until the patient is comatose, you have missed part of it's usefulness. All patients with head injuries should have a baseline and serial GCS assessments as well as a narrative describing their level of consciousness as appropriate. If a person had a baseline GCS of 15, then declined to a 13 or less, that is a significant change. If the GCS wasn't assessed until after the patient became comatose, we would lose some of its value.

Don't ridicule your coworkers for using the scale appropriately. I find it disturbing that some head injured patients do not have a GCS done as part of their initial assessment. The GCS is an integral part of the Revised Trauma Score used in most trauma centers in the US. You should not wait until the patient is in a coma before you use it. Tachycardia and hypotension are hallmarks of shock, but you don't wait for the patient to be in shock before you begin to assess for it.

Chuck

Dplear · Aug 25, 2002

Actually as a neuro nurse we use the glasgow coma scale quite a bit. It is used to measure LOC as well as orientation. You would use it on a completely oriented person to obtain a baseline measurement. Without it if they should have a stroke a new person walks in on the care, they would not know if this is the persons baseline. It is also important to break down the scale into its 3 components and give the score for each section, as without it broken down, the score can be added up differently and not show what part of the scale they are having problems with. It is a very legitimate admission scale and test to give all pt's.

Dave

TELEpathicRN · Aug 25, 2002

I also think it is a valuable part of an admission assessment, just as valuable as baseline labs, vital signs, tele strips, etc.... Maybe you should start performing the GCS since it is on your admit assessment and see if it is ever beneficial to you. I know it has helped me in the past. For example, if you get a "half-ass" report (as many of us do) from our co-workers or someone who was floated to your unit, and you go see a pt and they are disoriented or unable to speak, etc... you could look back at the GCS and see what the baseline was.

Trauma Columnist · Aug 25, 2002

GCS is the standard of care today for every pt with possible alt mental status and who has had loss of consciousness. In our level one trauma center, we use it on everyone - its part of our assessment tool. Also the ENA (Emergency Nurses Association) rates it very highly and recommends use routinely along with RTS (Revised Trauma Score) for ANY trauma pt.

MollyJ · Aug 25, 2002

LONG AGO in my ED days, we did GCS on every patient, even those presenting for laceration repair, say to a hand. The nice thing about having a GCS on everyone is that when you did have someone who had a change in LOC right there in the ED, the nurse had, by habit and protocol, already done a baseline assessment of LOC and it promoted your certainty that what you were seeing was a change in LOC.

fedupnurse · Aug 25, 2002

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.

P_RN, ADN, RN · Aug 25, 2002

Us too. GCS on everyone to document the 'baseline." It is in the computer and "IF IT IS IN THE COMPUTER, THEN I MUST BE A REQUIRED ASSESSMENT!" (NM and CNS in concert.)

Almost all are what a 15? Is that right? But with such short hsp stays and so many patients what's the extra 2 minutes?

BTW there is a nice assessment algorithem set at:

http://www.medal.org/index.html

bestblondRN · Aug 25, 2002

The GCS is used to measure LOC. If you want to measure level of coma, you would use something like the Rancho Los Amigos scale.

Hope that helps! :)

dawngloves, BSN, RN · Aug 26, 2002

I've done a GCS on all neuro pts. Obviously if you have a cardiac walky talky you don't do one.I would just put a N/A on the assesment form.

CEN35 · Aug 26, 2002

despite why it was made or what the initial purpose is i have to say a few things.

#1 if they are in a true coma, then half that doesn't apply anyways?

#2 i do it on all patients!

why?

you don't always have time to have an in depth discussion, or repeat assessment on a patient. lot's of things can cause the numbers on a gcs to change. inability to express oneself (i.e. cva), disorientation (i.e. cva, od, chi, global amnesia). i can go on and on. i use it all the time, it's fast quick and easy, and shows you have at least paid some attention to the person.

me :)

MPHkatie · Aug 26, 2002

Your colleagues are actually using the test correctly. As there are several levels of conciousness measured by the GCS.(you can't go just by the names) Most are not comatose. Generally with alert patients, you can actually do a GCS while doing your exam- that does take a bit of attention: when you ask the pt to straighten the arm that is causing the IV pump to beep incessantly- do they do it? well, then they follow commands- it actually doesn't take that must time to do, but I will add to the chorus, it should be done.