Emergency in medical by Glasgow coma scale

Emergencies
1- Coma: Glasgow coma scale (GCS) is used to describe the general level of consciousness
in patients with traumatic brain injury (TBI) and to define broad categories of head injury. The GCS is divided in 3 categories, eye opening (E), motor response (M) and verbal
response (V). The score is determined by the sum of the score in each of the 3 categories, with a maximum score of 15 and a minimum score of 3. GCS= E+M+V. causes of
impaired conscious level/coma:
Metabolic: - drugs, poisoning, eg. Carbone monoxide, alcohol, tricyclics. – Hypoglycaemia, hyperglycaemia. – Hypoxia, CO2, narcosis (COPD). - Septicaemia. - Hypothermia. – Myxoedema, addisonia crisis. – Hepatic/uraemic encephalopathy
Neurologic: - trauma. – Infection: meningitis; encephalitis, eg. Herpes simplex gives aciclovir
intravenous. – Typhoid, typhus, trypanosomiasis. – Tumour: 1
st degree or 2nd degree. – Vascular:
stroke, subdural/subarachnoid, hypertensive encephalopathy. – Epilepsy: non-convulsive status
or post-ictal state.
Treatment: immediate management
a. If , GCS≤8 consider: Airway, Breathing and circulation. b. If GCS˂8: give O2 and treat seizure
c. If possible hypoglycaemia: start with glucose 500ml 20% intravenous
d. If Wernicke’s encephalopathy: give thiamine intravenous
e. For opiate intoxication: naloxone 0.4-2mg intravenous/intramuscular or
f. For benzodiazepine intoxication: flumazenil 200µg intravenous over 15second, up to
1000µg at 60second if need
2- Glasgow coma scale: this gives a reliable way of recording the conscious state of a
person. It can be used by medical and nursing staff for initial assessment. It has value in
predicting ultimate outcome. 3 types of response are assessed, note in each case the best
response (or best of any limb) which should be recorded. Best motor response Best verbal response Eye opening
6 Obeying commands 5 oriented (time, place, person) 4 spontaneous
5 localizing pain 4 confused conversation 3 in response to speech
4 withdrawing to pain 3 inappropriate speech 2 in response to pain
3 flexor response pain 2 incomprehensible sound 1 none
2 extensor response to pain 1 none
1 none response to pain
The score in the 3 areas assessed:
No response to pain + no verbalization + no eye opening = 3
Severe injury, GCS≤8 consider airway protection
Moderate injury, GCS 9-12
Minor injury, GCS 13-15
Abbreviation of coma scale, AVPU is sometimes used in initial assessment “primary survey” of the critically ill.