GCS Scoring - Scenerios

[chevy]

Just starting to learn the GCS scoring system and I'm looking for input on the following scenarios:

#1

Motor: How would you score the Motor component of a Pt. who cannot move one side of their body when asked. E=4,V=5. (possible CVA).

-I'm thinking 5 but interested in other thoughts.

#2

In the case of a normally aphasic handicapped person, how much do you rely on the usual caregiver in trying the judge normal character of a pt? btw - I'd doc this one whatever the score.

#3.

If the only response to painful stimuli is verbal (moan), what is the Motor score?

#4.

When arriving on scene, Pt has eyes covered due to forehead lac. First responder says that vision was ok. Do you re-expose the wound to evaluate? I am thinking to mark Vision as 4 but note that it was per:1st responder and unable to check due to lac. Comments?

..chevy

[CoyoteMedic]

#1: They can still move, on command, any extremity, then its a 5. What you seam to be talking about is a CVA, and thats a different scale.

#2: Going by the book, you have to give them a 1. Best thing you can do is question the caretaker. They know the pt best, and can tell you if there is anything abnormal about the presentation. I have heard of modified GCS scales out there, but have not actully seen one.

#3: If they don't move, its a 1. If they don't open their eyes, its a 1, if they just moan, its a 2 for incomprehensible

#4: Depending on where the lac is. if its in a spot where the bandage can be removed for assessment of the eyes, then yes you need to. Especially if the pt is altered in anyway. Did they fall and smack their head? Did someone try to play baseball with their head and hit a homerun? Or did someone just mistake their head as a carving board. If the lac is on the eyes tho, then no, your not going to be able to determin, and you relay that to the hospital in yoru call in and your report at the hospital.

Hope that helps any.

[MedicRN]

Just starting to learn the GCS scoring system and I'm looking for input on the following scenarios:

#1

Motor: How would you score the Motor component of a Pt. who cannot move one side of their body when asked. E=4,V=5. (possible CVA).

-I'm thinking 5 but interested in other thoughts.

If they are moving to command, then I'd document M=6 and then expound in your narrative as to which side moved, where any weakness was noted, etc.

#2

In the case of a normally aphasic handicapped person, how much do you rely on the usual caregiver in trying the judge normal character of a pt? btw - I'd doc this one whatever the score.

If they are able to 'play 20 Questions' (answer yes/no correctly), then I would score appropriate to response and expound in the narrative.

#3.

If the only response to painful stimuli is verbal (moan), what is the Motor score?

Did they reach for the point of pain (M=5)? Did they pull back the extremity from the pain (M=4)? Did they abnormally flex (decorticate posture) the extremity(ies) to pain (M=3)? Did they abnormally extend (decerebrate posture) the extremity(ies) to pain (M=2)? Did they lay there like a lump (M=1)?

#4.

When arriving on scene, Pt has eyes covered due to forehead lac. First responder says that vision was ok. Do you re-expose the wound to evaluate? I am thinking to mark Vision as 4 but note that it was per:1st responder and unable to check due to lac.

Remember, GCS is not a measurement of vision, but rather if the patient opens eyes spontaneously (4), tp speech (3), to pain (2) or does not open to any stimulus (1).

If I'm concerned about visual acuity, then if it is just a forehead lac, I'd remove the dressing and check. If there is any possibility of globe damage, then the bandage stays in place and appropriate documentation is made ('Per FR, potential damage to eye globe. Pt described good vision prior to bandage placement.')