Thread by @k_scheitler

Need help remembering how to compute a Glasgow Coma Scale (GCS) score?
 
A thread:

How to quickly and reliably compute GCS without having to look it up every time 😎👇🧵🧠

/1

The Glasgow Coma Scale (GCS) was first published in the 1970s and was intended to describe a patient's level of consciousness following traumatic brain injury.

/2

GCS has 3 components:
 
👀 Eye-opening (4 points)
👄 Verbal (5 pts)
💪 Motor (6 pts)
 
Don't memorize this!

When I was a student, someone taught me to remember this simply as:
 
EYES (4 letters = 4 total pts)
WORDS (5 letters = 5 total pts)
MOVING (6 letters = 6 total pts)

/3

Breaking it down further:

EYES (4 letters = 4 possible points!)

4 - spontaneous
3 - to voice
2 - to pain
1 - none

/4

WORDS (5 letters = 5 possible points!)

5 - fully oriented
4 - confused
3 - inappropriate words
2 - incomprehensible sounds
1 or T - nothing or intubated (still give one point)

/5

MOVING

6 - follows commands

5 - localizes to pain

4 - withdraws to pain

3 - decorticate (I remember this b/c the French word for 'heart' is 'coeur' - arms flex toward the heart)

2 - decerebrate (arms extend away from the cerebrum)

1 - nothing

/6

IMPORTANT:

-Score GCS by including the best response in each category - e.g., if half of one person’s body is following commands, but the other half isn’t, the motor score is still 6.

-It is important to realize that the lowest possible GCS score is 3 (NOT zero).

/7

ALWAYS CONFIRM THAT AN INTUBATED PATIENT IS NOT UNDER THE INFLUENCE OF PARALYTIC. THIS REQUIRES TRAIN OF FOURS.

I recommend this in ALL trauma scenarios, regardless of whether you know if/when paralytic was given.

Let me tell you a story.

/8

While evaluating a trauma pt, I was told
that GCS 3T (coma). Pt reportedly was
intubated/paralyzed/sedated 2 hours
prior (long past the half-life of the
paralytic).

I brought a train of fours machine anyway
& tested the pt. No twitches -- aka, the
pt was still paralyzed.

/9

Paralytic reversal was promptly
administered.

Pt immediately began following
commands AND opening eyes to voice --
aka, GCS was 10T (E3VTM6).

👀 👀

/10

SUMMARY part 1:

🌀 GCS is used to convey a patient's
level of consciousness after brain injury.
It asks:

Do the eyes open?
Does the mouth speak?
Does the body follow commands?

The answers to these questions tell us
about the severity of the underlying brain
injury.

/11

SUMMARY part 2:

🌀 Accurate GCS testing is confounded
by medications commonly administered
in the trauma setting - e.g.,
neuromuscular blockade, sedation,
narcotics, &c. You must:

ALWAYS pause sedation.

ALWAYS confirm the absence of
paralytic (train of fours).

/12