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The Glasgow Coma Scale

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This page consist of online training for EMS personnel.  The subject of training is "The Unresponsive Patient and the "Glasgow Coma Scale".  To see more training topics,  Click Here!



The Unresponsive Patient and the "Glasgow Coma Score


Perhaps one of the most difficult of calls for the EMS professional is the Comatose Patient.   Here we will attempt to provide an understanding of the Glasgow Coma Scale and how the scale works.   This is perhaps our best method of evaluating the Comatose Patient in the field.   A good understanding of the Glasgow Coma Scale is essential for all EMS providers,  and a tremendous help to the Hospital ER staff when communicating a Patient Report.   If you need further assistance with the the Glasgow Coma Scale, feel free to E-Mail us.

Explanation of the Glasgow Coma Scale

Eye Opening:

This test indicates the function of the brain's activites.   The Patient's eyes may open spontaneously,  maybe only on verbal request, or only to painful stimulation.

Best Verbal Response:

Indicates the condition of the Central Nervous System within the Cerebral Cortex.   The patient may be able to speak normally and be oriented to time and place, or he/she may be disoriented and use inappropriate words.   At the other end of the scale,  the patient may only make incomprehensible sounds or no sound at all.

Best Motor Response:

This test examines the patient's ability to move upper and lower extremities.   Responses may vary from the ability to move on command to the ability to move only in response to painful stimuli.

Each element of the Glasgow Coma Scale is rated using numbers such as "1",  the lowest possible score in each category.   Physicians classify brain injuries as mild,  moderate,  or severe depending on the score obtained from this scale.

The Glasgow Score is obtained by adding the score of each section together to obtain a total score.

Eye Opening:  (E)

"1" to "4"

"1" being the lowest score possible, "4" being the highest score possible.

Best Motor Response:  (M)

"1" to "6"

"1" being the lowest score possible, "6" being the highest score possible.

Best Verbal Response:  (V)

"1" to "5"

"1" being the lowest score possible, "5" being the highest score possible.

The following charts are the most common method of utilizing the Glasgow Coma Scale.   It is essential for EMS Providers to learn,  understand and retain the Glasgow Coma Scale.   The following tables break down the Glasgow Coma Scale.

THE GLASGOW COMA SCALE!

Eye Opening
Score
Characteristics
None1Eyes always closed; not attributable to occular edema
To Pain2Eyes open in response to painful stimlus
To Speech3Eyes open in response to speech or shouting; does not imply patient obeys command to open eyes
Spontaneous4Eyes open; does not imply intact awareness

Best Motor Response
Score
Characteristics
No Response1No motor response to pain
Extension2Extension at olecranon
Abnormal flexion3Includes preceding extension, stereotyped flexion posture, extreme wrist flexion, abduction of upper arm, flexion of fingers over the thumb; if unsure, score as withdrawal
Withdrawal4Normal flexor withdrawal; no localizing attempt to remove stimulus
Localizes pain5Attempt made to remove stimulus, e.g., hand moves above chin toward supraocular stimulus
Obeys commands6Follows simple commands

Best Verbal Response
Score
Characteristics
No Response1No sounds
Incomprehensible2Moaning, groaning, grunting; imcomprehensible
Inappropriate3Intellibgible words, but not in a meaningful exchange; e.g., shouting, swearing, no meaningful conversation
Confused4Responds to questions in conversational manner, but responses indicate varying degrees of disorientation and confusion
Oriented5Normal orientation to time, place, person; appropriate conversation

The Glasgow Coma Scale and the Scores

Eye movement + Best Motor Response + Best Verbal Response = total score:

EXAMPLE:

Eye Movement = 3

+

Best Motor Response = 5

+

Best Verbal Response = 5

___________________________

Total score equals 13 on the Glasgow Coma Scale.

What do these scores mean?

  • Less than or equal to 8 are considered to be in a true coma.

  • Greater than or equal to 9 usually are not in a true coma.

  • 8 or less means the patient is in critical condition.

  • Less than or equal to 8 at 6 hours after incident - 50% die usually die.

  • 9 to 11 equals moderate condition in severity.

  • Greater than or equal to 12 equals usually minor in severity.

Coma is Defined as:

  • 1.   Not opening eyes

  • 2.   Not obeying commands

  • 3.   Not speaking understandable words

    Feel free to use this information in any way you wish,  you may copy, or save this information on disk and use in anyway helpful.  Any questions?  Please E-mail us and let us know, we are always happy to assist in anyway we can.



    This Site Designed and Maintained by:Lee Sampson/Flight Paramedic
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