GCS - What we know Vs what we don't know

Do you undertake a Glasgow Coma Scale on your patients?

Doing a Glasgow Coma Scale (GCS) and understanding a GCS are two different things…

BUT what are we really assessing?

The first component of the assessment provides a score for the “eyes”. Providing a score between 0-4. What does that actually mean?

The truth is, we are assessing the RETICULAR ACTIVATING SYSTEM.

Ok..?

So, What the hell, is the Reticular Activating System!

I would describe it as one of the most interesting parts of the human body. It is the system that helps link the sensory network to the conscious mind. Essentially, we are assessing their level of consciousness or how their wakefulness and sleep-wake transitions. We are NOT assessing how their eyes work.. !

Giuseppe Moruzzi. Giuseppe Moruzzi (July 30, 1910 – March 11, 1986) was an Italina Neurophysiologist and helped link wakefulness to the RAS. The GCS as a collective was invented in 1974 by Graham Teasdale and Bryan J. Jennett, professors of neurosurgery and you would never guess where they worked…..University og Glasgow! An amazing campus if you are ever in Glasgow, you should visit. You should also get a curry there!! Tasty!

The Best tips we have for assessing eyes within GCS

• Always score the patient, the best score you can give them
• Always be aware of whatever drugs they may have onboard that could effect that score i.e.
  • Propofol or Fentanyl, if they are intubated and ventilated or alcohol if it is in ED late on a Saturday night and they are cooked on alcohol or meth!
• Do they have any significant sub-cutaneous emphysema that is impacting their mechanical ability to open their eyes or swelling etc…
• BIG TIP: Whenever you deliver a painful stimulus when assessing eyes, this must be done as a peripheral stimulus. If you provide a central stimulus they are likely to grimace and intrinsically close their eyes. This is counter intuitive to your assessment. ALWAYS PERIPHERAL ASSESSMENT FOR Pain stimulus in The E score of the GCS

What do you find challenging about doing a GCS?

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