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Head Injury (cont.)

Head Injury Guidelines and Assessment: Glasgow Coma Scale

The Glasgow Coma Scale was developed to provide a simple way for health care practitioners of different skill levels and training to quickly assess a patient's mental status and depth of coma based upon observations of eye opening, speech, and movement. Patients in the deepest level of coma:

  • do not respond with any body movement to pain,
  • do not have any speech, and
  • do not open their eyes.

Those in lighter comas may offer some response, to the point they may even seem awake, yet meet the criteria of coma because they do not respond to their environment.

Glasgow Coma Scale
Eye Opening  
Spontaneous 4
To loud voice 3
To pain 2
None 1
Verbal Response  
Oriented 5
Confused, Disoriented 4
Inappropriate words 3
Incomprehensible words 2
None 1
Motor Response  
Obeys commands 6
Localizes pain 5
Withdraws from pain 4
Abnormal flexion posturing 3
Extensor posturing 2
None 1

Glasgow Coma Scale

A person who is awake has a Glasgow Coma Scale of 15, while a person who is dead would have a score of 3. The abnormal motor responses of flexion and extension describe arm and leg movement when a painful stimulus is applied.

  • The term "decorticate" (de=not + cortex=conscious part of the brain) refers to the cortex of the brain, the part that deals with movement, sensation, and thinking.
  • "Decerebrate" (de=not + cerebrum= brain and brainstem) means that the cortex and the brain stem that unconsciously controls basic bodily functions like breathing and heart beat, may not functioning.

Trauma patients are often "touched" by many health care practitioners; from first responders, EMTs,  emergency physicians, surgeons and neurosurgeons. Not only is it important to assess the depth of coma but also to know if the patient is improving or deteriorating. The Glasgow Coma Scale allows that analysis to occur.

The scale is used as part of the initial evaluation of a patient, but does not assist in making the diagnosis as to the cause of coma. Since it "scores" the level of coma, the GCS can be used as a standard method for any health care practitioner to assess change in patient status.

When Should I Call the Doctor About a Head Injury?

  • Call 911 or activate your local emergency response service should any person sustain a significant head injury. This includes all persons with loss of consciousness who do not immediately waken and return to normal as well as those who show signs of weakness or numbness on one side of their body, complain of difficulty speaking, or have vision loss. These are the same symptoms as a person having a stroke.
  • Mechanism of injury is also an important consideration. Persons in a motor vehicle collision or who have fallen from a height should be kept still with their neck protected, in case there is an associated spinal cord injury.
  • Other symptoms that should prompt seeking medical care include confusion, loss of short-term memory, and repeated vomiting.
  • A less specific symptom but one that can also be used with children is to decide whether the person is acting like his or herself. This is a subtle and non specific way of evaluating an injured person, but if there is concern that they are not acting "normal", medical care should be accessed.
  • Persons with head injuries who are impaired because of alcohol or drugs should be brought for medical attention and evaluation.
  • Those who are taking prescription blood thinning medications such as warfarin (Coumadin), dabigatran etexilate (Pradaxa), enoxaparin (Lovenox), and heparin should seek medical care for all head injuries, even if it is very minor.
Medically Reviewed by a Doctor on 11/8/2016

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