Deteriorating Patient
Deteriorating Patient
 

Level of Alertness

 
 
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Overview

  • The Glasgow Coma Scale (GCS) is a 15-point scale indicating level of consciousness.
    • How to Assess

    • If the patient is not spontaneously opening their eyes, begin by attempting to elicit a response verbally. If this is unsuccessful then apply a painful stimulus such as a trapezius squeeze or a sternal rub.
  • If not done in this order, the examiner is unable to determine whether the patient responded to the painful stimulus or the voice.
    • Interpretation

    • Causes of Reduced Glasgow Coma Scale

    • Intracranial

    • Haemorrhage - intracerebral, subarachnoid, subdural, extradural
    • Infarction
    • Infection - meningitis, encephalitis, abscess
    • Tumour - mass effect, cerebral oedema
    • Post ictal state
    • Head trauma - vascular, hypoxia, cerebral oedema, parenchymal injury
    • Psychiatric - conversion disorder, depression, catatonia
    • Extracranial

    • Cardiovascular - shock, hypertension
    • Infection - septicaemia
    • Metabolic - hypo/hyperosmolar states, hypo/hyperglycaemia, hypoadrenalism, hypothyroidism, hypopituitarism, electrolyte abnormality, hypercapnia
    • Drugs / toxins - sedatives, analgesics, alcohol
    • Physical injury - hyper / hypothermia, electrocution
 
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