This app is intended to help students learn the Glasgow Coma Scale (GCS) for infants (patients to 1 year old.)
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The Glasgow Coma Scale is a neurological assessment method based on numerically scoring eye, verbal, and motor responses on respective scores of 1 to 4, 1 to 5, and 1 to 6.
The scores may be used individually to track neurological changes and may be summed to provide an overall picture of neurological function. The lower the score is, the lower the function is.
An adult found with closed eyes, non-talking, and not oriented and alert is typically further assessed with a painful stimulus.
It is important to remember that the lowest possible score in each category (a "No response") is 1 and not 0.
A response that is impossible to determine because of local factors, such as an eye response in a congenitally blind patient, is either scored NT for "non-testable," or noted in the patient care report per local protocols. It has been said that an Egyptian mummy has a GCS of 3. This can help you to remember the lower end of the Scale, but a more realistic measure for a mummy would be 3 NTs.
In any case, one mnemonic to help remember the GCS is to think of an eye-opening, V5, Scottish motorcycle. The improper use of such an unusual machine might precede the need for the proper use of the GCS.
The first part of "eye-opening, V5, Scottish motorcycle," corresponds to the "Eye response" category of the GCS. The 4 syllables of "eye-opening" correspond to the first category's highest possible score.
In the second part of "eye-opening, V5, Scottish motorcycle," the "V" corresponds to the Verbal category, and the "5" corresponds to the second category's highest possible score. By remembering that the upper possible scores of the three categories vary by 1, the "5" in the middle part of the three-part mnemonic can remind one of the upper range of category scores: 4, 5, and 6.
In the third part of "eye-opening, V5, Scottish motorcycle," "Motor" corresponds to the GCS's last category, and the syllable count in "Scottish motorcycle" corresponds to the last category's highest possible score.
The Royal College of Physicians and Surgeons of Glasgow has a website with assessment and recording protocols, an instructional video, references to pertinent literature, and FAQ's: https://www.glasgowcomascale.org/.
There are various local nuances to GCS protocols, primarily in the nomenclature, which, all else being equal, seem to result in equivalent or very close to equivalent final scores.
Since L.A. County's population is greater that of 40 individual US states, the following criteria are from L.A. County's 06-01-18 protocols. A few clarifications have been inserted in brackets:
| Eye Response Criteria | |
|---|---|
| [Open] Spontaneous | 4 |
| [Open] to Shout | 3 |
| [Open] to Pain | 2 |
| None | 1 |
| Verbal Response Criteria | |
| Smiles and coos appropriately | 5 |
| Cries and consolable | 4 |
| Persistent inappropriate crying and/or screaming | 3 |
| Grunts or is agitated or is restless | 2 |
| None | 1 |
| Motor Response Criteria | |
| Spontaneous | 6 |
| Localizes to pain | 5 |
| Withdraws to pain | 4 |
| Flexion (decorticate) | 3 |
| Extension (dDecerebrate) | 2 |
| None | 1 |
A useful mnemonic to remember is "“Less than eight, intubate.” This simply means that a GCS score of less than 8 less typically indicates a need for endotracheal intubation.
Note the nomenclature difference between the Glasgow Coma Scale and the Apgar (or APGAR) Score. The Glasgow Coma Scale refers to a system containing a final score commonly called a GCS. (i.e. "Patient has a GCS of 3.") The Apgar Score refers to both a system and a final sum of the system's individual scores.
The distinction can be remembered by focusing on the ale in Scale. A baby (rated with the Apgar Score) would not be drinking ale. An ale-drinking biker riding an eye-opening, V5, Scottish motorcycle could easily be in need of the Scale.
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