Glasgow Coma Scale
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Glasgow Coma Scale
The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a person's level of consciousness after a brain injury. The GCS assesses a person based on their ability to perform eye movements, speak, and move their body. These three behaviours make up the three elements of the scale: eye, verbal, and motor. A person's GCS score can range from 3 (completely unresponsive) to 15 (responsive). This score is used to guide immediate medical care after a brain injury (such as a car accident) and also to monitor hospitalised patients and track their level of consciousness. Lower GCS scores are correlated with higher risk of death. However, the GCS score alone should not be used on its own to predict the outcome for an individual person with brain injury. Scoring The Glasgow Coma Scale is used for people above the age of two and composed of three tests: eye, verbal, and motor responses. The scores for each of these tests are indicated in the table below. The Glasgow Com ...
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Scale (ratio)
The scale ratio of a model represents the proportional ratio of a linear dimension of the model to the same feature of the original. Examples include a 3-dimensional scale model of a building or the scale drawings of the elevations or plans of a building. In such cases the scale is dimensionless and exact throughout the model or drawing. The scale can be expressed in four ways: in words (a lexical scale), as a ratio, as a fraction and as a graphical (bar) scale. Thus on an architect's drawing one might read 'one centimeter to one meter', 1:100, 1/100, or . A bar scale would also normally appear on the drawing. Colon may also be substituted with a specific, slightly raised ratio symbol , ie. . General representation In general a representation may involve more than one scale at the same time. For example, a drawing showing a new road in elevation might use different horizontal and vertical scales. An elevation of a bridge might be annotated with arrows with a length proport ...
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Decorticate Response
Abnormal posturing is an involuntary flexion or extension of the arms and legs, indicating severe brain injury. It occurs when one set of muscles becomes incapacitated while the opposing set is not, and an external stimulus such as pain causes the working set of muscles to contract.AllRefer.com. 200"Decorticate Posture". Retrieved January 15, 2007. The posturing may also occur without a stimulus.WrongDiagnosis.com(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series). Retrieved on September 15, 2007. Since posturing is an important indicator of the amount of damage that has occurred to the brain, it is used by medical professionals to measure the severity of a coma with the Glasgow Coma Scale (for adults) and the Pediatric Glasgow Coma Scale (for infants). The presence of abnormal posturing indicates a severe medical emergency requiring immediate medical attention. Decerebrate and decorticate posturing are strongly associated with poor outcome in a variety ...
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Coma
A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move. Comas can be derived by natural causes, or can be medically induced. Clinically, a coma can be defined as the inability consistently to follow a one-step command. It can also be defined as a score of ≤ 8 on the Glasgow Coma Scale (GCS) lasting ≥ 6 hours. For a patient to maintain consciousness, the components of ''wakefulness'' and ''awareness'' must be maintained. Wakefulness describes the quantitative degree of consciousness, whereas awareness relates to the qualitative aspects of the functions mediated by the cortex, including cognitive abilities such as attention, sensory perception, explicit memory, language, the execution of tasks, temporal ...
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Triage
In medicine, triage () is a practice invoked when acute care cannot be provided for lack of resources. The process rations care towards those who are most in need of immediate care, and who benefit most from it. More generally it refers to prioritisation of medical care as a whole. In its acute form it is most often required on the battlefield, during a pandemic, or at peacetime when an accident results in a mass casualty which swamps nearby healthcare facilities' capacity. Triage always follows the modern interpretation of the Hippocratic oath, but otherwise there is plenty of leeway in interpretation, leading to more than one simultaneous idea of its nature. The best settled theories and practical scoring systems used in here come from the area of acute physical trauma in an emergency room setting; a broken bone obviously counts for less than uncontrolled arterial bleeding, apt to lead to death. But no current principle carries too well over to mental health, reproductive heal ...
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Revised Trauma Score
The Revised Trauma Score (RTS) is a physiologic scoring system based on the initial vital signs of a patient. A lower score indicates a higher severity of injury. Use in triage The Revised Trauma Score is made up of three categories: Glasgow Coma Scale, systolic blood pressure, and respiratory rate. The score range is 0–12. In START triage In medicine, triage () is a practice invoked when acute care cannot be provided for lack of resources. The process rations care towards those who are most in need of immediate care, and who benefit most from it. More generally it refers to prio ..., a patient with an RTS score of 12 is labeled delayed, 11 is urgent, and 3–10 is immediate. Those who have an RTS below 3 are declared dead and should not receive certain care because they are highly unlikely to survive without a significant amount of resources. Scoring The score is as follows: These three scores (Glasgow Coma Scale, Systolic Blood Pressure, Respiratory Rate) are then us ...
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Early Warning Score
An early warning score (EWS) is a guide used by medical services to quickly determine the degree of illness of a patient. It is based on the vital signs (respiratory rate, oxygen saturation, temperature, blood pressure, pulse/heart rate, AVPU response). Scores were developed in the late 1990s when studies showed that in-hospital deterioration and cardiac arrest were often preceded by a period of increasing abnormalities in the vital signs. Principles The resulting observations are compared to a normal range to generate a single composite score, for instance based on the following diagram (an early modified EWS): A score of five or more is statistically linked to increased likelihood of death or admission to an intensive care unit. Within hospitals, the EWS is used as part of a "track-and-trigger" system whereby an increasing score produces an escalated response varying from increasing the frequency of patient's observations (for a low score) up to urgent review by a rapid respo ...
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Blantyre Coma Scale
The Blantyre coma scale is a modification of the Pediatric Glasgow Coma Scale, designed to assess malarial coma in children. It was designed by Terrie Taylor and Malcolm Molyneux in 1987, and named for the Malawian city of Blantyre Blantyre () is Malawi's centre of finance and commerce, and its second largest city, with an enumerated 800,264 inhabitants . It is sometimes referred to as the commercial and industrial capital of Malawi as opposed to the political capital, L ..., site of the Blantyre Malaria Project.Taylor, T. (2009) Caring for children with cerebral malaria: insights gleaned from 20 years on a research ward in Malawi. Transactions of the Royal Society of Tropical Medicine and Hygiene 103 (Suppl 1): S6-S10 DoI: 10.1016/j.trstmh.2008.10.049 Using the scale The score assigned by the Blantyre coma scale is a number from 0 to 5. The score is determined by adding the results from three groups: Motor response, verbal response, and eye movement. The minimum score is ...
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AVPU
The AVPU scale (an acronym from "alert, verbal, pain, unresponsive") is a system by which a health care professional can measure and record a patient's level of consciousness. It is mostly used in emergency medicine protocols, and within first aid. It is a simplification of the Glasgow Coma Scale, which assesses a patient response in three measures: eyes, voice and motor skills. The AVPU scale should be assessed using these three identifiable traits, looking for the best response of each. Meaning of the mnemonic The AVPU scale has four possible outcomes for recording (as opposed to the 13 possible outcomes on the Glasgow Coma Scale). The assessor should always work from best (A) to worst (U) to avoid unnecessary tests on patients who are clearly conscious. The four possible recordable outcomes are: * Alert: The patient is fully awake (although not necessarily oriented). This patient will have spontaneously open eyes, will respond to voice (although may be confused) and will have b ...
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FOUR Score
The FOUR Score is a clinical grading scale designed for use by medical professionals in the assessment of patients with impaired level of consciousness. It was developed by Dr. Eelco F.M. Wijdicks and colleagues in Neurocritical care at the Mayo Clinic in Rochester, Minnesota. "FOUR" in this context is an acronym for "Full Outline of UnResponsiveness". The FOUR Score is a 17-point scale (with potential scores ranging from 0 - 16). Decreasing FOUR Score is associated with worsening level of consciousness. The FOUR Score assesses four domains of neurological function: eye responses, motor responses, brainstem reflexes, and breathing pattern. The rationale for the development of the FOUR Score constituted creation of a clinical grading scale for the assessment of patients with impaired level of consciousness that can be used in patients with or without endotracheal intubation. The main clinical grading scale in use for patients with impaired level of consciousness has historically bee ...
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Simplified Motor Scale
Simplified motor scales (SMS) refer to a neurological evaluation that is designed to provide a meaningful, objective prognostic evaluation of an individual. SMS have been proposed as alternatives that would improve upon the Glasgow Coma Scale The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a person's level of consciousness after a brain injury. The GCS assesses a person based on their ability to perform eye movements, speak, and move their body. These thre ... challenges of being confusing, unreliable and unnecessarily complex. An example of a SMS can be remembered by the mnemonic "TROLL" for Test Responses: Obeys, Localizes, or Less. The scale was created by Dr Stephen Green in 2011. He wrote an editorial for the Annals of Emergency Medicine strongly opposing the use of the GCS, stating that, compared to a general assessment, simple unstructured clinical judgement can be just as accurate and that the GCS itself has poor reliability. «Literature e ...
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Inter-rater Reliability
In statistics, inter-rater reliability (also called by various similar names, such as inter-rater agreement, inter-rater concordance, inter-observer reliability, inter-coder reliability, and so on) is the degree of agreement among independent observers who rate, code, or assess the same phenomenon. Assessment tools that rely on ratings must exhibit good inter-rater reliability, otherwise they are not valid tests. There are a number of statistics that can be used to determine inter-rater reliability. Different statistics are appropriate for different types of measurement. Some options are joint-probability of agreement, such as Cohen's kappa, Scott's pi and Fleiss' kappa; or inter-rater correlation, concordance correlation coefficient, intra-class correlation, and Krippendorff's alpha. Concept There are several operational definitions of "inter-rater reliability," reflecting different viewpoints about what is a reliable agreement between raters. There are three operational defin ...
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Graham Teasdale (physician)
Sir Graham Michael Teasdale (born 23 September 1940) is an English neurosurgeon and the co-developer of the neurologic assessment tool known as the Glasgow Coma Scale. He is an Honorary Professor in Mental Health and Wellbeing in the Institute of Health and Wellbeing at the University of Glasgow Medical School. Biography Born in Spennymoor, County Durham, Teasdale attended medical school at the University of Durham, graduating MB, BS in 1963. He has been associated with the University of Glasgow Medical School since the 1960s. In 1974, Teasdale co-created the Glasgow Coma Scale (GCS) with Bryan Jennett. The GCS is a method of assessing a patient's level of consciousness. After serving as president of the Society of British Neurological Surgeons from 2000 to 2002, he was president of the Royal College of Physicians and Surgeons of Glasgow from 2003 to 2006. He was made a Knight Bachelor in 2006. He received the 2014 Distinguished Service Award from the American Association of N ...
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