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Conscious Level
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The First Seizure
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Coma
Conscious Level
Last updated 26th March 2024
Glasgow Coma Scale (Best = 15, Worst = 3)
Coma is defined by Glasgow Coma Scale (GCS) <8 which correlates roughly with V on AVPU & with the ability to maintain a patent airway.
ALL at this level or below likely to need airway maintained by intervention, some of those above this level will
Score | ||
---|---|---|
Eyes Open(E) (Eyes closed by swelling = C) | Spontaneously | 4 |
To Speech | 3 | |
To paina | 2 | |
None | 1 | |
Best Motor Response | Obeys Commands b | 6 |
Localises Painc | 5 | |
Flexion/withdrawald | 4 | |
Flexion abnormal to paine | 3 | |
Extension to painf | 2 | |
None | 1 | |
Best Verbal Response (V) (Intubated = T) (Record if intubated) | Orientatedg | 5 |
Confused | 4 | |
Inappropriate words | 3 | |
Inconprehensible sounds | 2 | |
None | 1 |
- a e.g. Pressure at supraorbital margin, but NOT a painful stimulus to lower limb because may elicit a spinal reflex and so be confused with an appropriate response b e.g. Ask patient to stick out tongue. Useful for patients with spinal injury which prevents them from moving their limbs.
- c Localising to pain involves lifting hands above clavicles for a supraorbital stimulus
- d. Requires patient to pull limb away from a stimulus to that limb
- e. Both arms flex, legs extend (decorticate)
- f. Both arms and legs extend (decerebrate)
- g. Must be able to say who they are, where they are and give current month correctly
Give E,M & V scores separately.
- GCS has been validated for adults only
- Eye and verbal scores are first to decrease, and motor score usually last to decrease
- Beware GCS of E4, V3, M1 – low motor score probably ↓ by something other than coma eg spinal cord transection
- Always measure blood glucose when faced with a patient with low conscious level
The ACVPU Scale
- AVPU was the original method of rapidly assessing level of consciousness, and this scale is still commonly referred to. With the development of NEWS2, new-onset confusion (‘C‘) was added to the score to make ACVPU.
- If patient responds only to P (painful stimulus) or is U (unresponsive) this is usually equivalent to a Glasgow Coma Scale of 8 or less ie coma, and indicates urgent airway management usually tracheal intubation.
ACVPU | How to Score |
---|---|
A = Alert | The patient is alert, awake, responsive to voice and orientated to person, time and place |
C = Confused | New confusion |
V = Verbal | The patient responds to voice but is not fully orientated to person, time and place |
P = Pain | The patient does not respond to voice but does respond to a painful stimulus, eg pinching the skin |
U = Unresponsive | The patient is unresponsive to both verbal and painful stimuli |
Content updated by Chris Isles