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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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