Level of consciousness (GCS)
-
Upload
sandra-gboneme -
Category
Health & Medicine
-
view
126 -
download
0
Transcript of Level of consciousness (GCS)
![Page 1: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/1.jpg)
LEVEL OF CONSCIOUSNESS
Recognition and Management
By GBONEME S.E
![Page 2: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/2.jpg)
OUTLINE
• INTRODUCTION
• DEFINITION OF TERMS
• AEITIOLOGY
• PATHOPHYSIOLOGY
• GLASGOW COMA SCORE
• INVESTIGATION
• MANAGMENT
![Page 3: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/3.jpg)
INTRODUCTION
Content
Arousal
Consciousness
![Page 4: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/4.jpg)
INTRODUCTION Contd
• Level of consciousness (LOC) is a measurement of a person's arousability and responsiveness to stimuli from the environment.
• Altered consciousness is one of the most common findings encountered by a neurosurgeon.
• Altered level of consciousness is a condition of being less responsive to and aware of external stimuli
![Page 5: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/5.jpg)
Definition of Terms
• CONFUSED: disoriented to surroundings, may have impaired
judgment, may need cues to respond to commands.
• LETHARGIC: Drowsy, needs gentle verbal or touch stimulation to initiate
response.
• OBTUNDED: responds slowly to external stimulation and needs
repeated stimulation to maintain attention and response
• STUPOROUS: responds only minimally with vigorous stimulation,
may only moan as a verbal response
• COMATOSE: no observable response to any external stimuli
![Page 6: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/6.jpg)
AEITIOLOGY
• Structural
Trauma: cerebral edema, subdural and epidural
hematoma.
Vascular: subarachnoid hemorrhage, infarction.
Infection: meningitis, encephalitis, brain abscess.
Neoplasms: metastatic tumor, primary brain tumor
![Page 7: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/7.jpg)
AEITIOLOGY Contd:
• Metabolic:
Toxicity: drugs (opiates), heavy metals, carbon monoxide
Systemic metabolic derangement: hypoglycemia,
hyponatremia, diabetic ketoacidosis, hyperglycemia
Extremities of body temperature: Heat stroke,
hypothermia
Hypoxic encephalopathy: severe anemia, severe
pulmonary disease, severe heart failure.
![Page 8: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/8.jpg)
PATHOPHYSIOLOGY
• Cellular brain edema or a disrupted chemical transmission at the receptor site results in faulty impulse transmission and impending communication within the brain or from the brain to other body parts.
![Page 9: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/9.jpg)
Glasgow Coma Scale
• Glasgow Coma Scale (GCS) is a neurological scale which aims to give a reliable and objective way of recording the conscious state of a person for initial as well as subsequent assessment.
• It is also useful in the classification of head injury
![Page 10: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/10.jpg)
![Page 11: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/11.jpg)
![Page 12: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/12.jpg)
![Page 13: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/13.jpg)
![Page 14: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/14.jpg)
CONTD:
• A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and 15.
• A score of 15/15 with no LOC – Mild head injury
• 14/15 or15/15 with LOC – Minor head injury
• 9 -13/15 – Moderate head Injury
• 3-8/15 – Severe head injury
![Page 15: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/15.jpg)
PHYSICAL EXAMINATION
![Page 16: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/16.jpg)
INVESTIGATIONS
• Complete blood count ( Rule out severe anemia evidenced by low RBC’S, decreased PCV. Also, infection, evidenced by elevated WBC’s and differentials).
• Blood Glucose ( Rule out Hypo/Hyper glycaemia)
• Electrolytes/ Urea/ Creatinine (Rule out electrolyte derangement as well as uremic encephalopathy)
• Imaging Studies:• X-ray
• CT-SCAN
• MRI
![Page 17: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/17.jpg)
RESUCUITATION
• The A..B..C..D’s
• A- Airway:• Stabilize Neck
• Ensure Airway is patent
• Suction if necessary
• Use of Airway adjunct.
• Use of endotracheal tube if indicated
• B- Breathing;• Use of mechanical ventilator is used to maintain adequate oxygenation
![Page 18: Level of consciousness (GCS)](https://reader031.fdocuments.us/reader031/viewer/2022021815/5a66dd9d7f8b9a3c0e8b5bd9/html5/thumbnails/18.jpg)
CONTD
• Circulation• Monitor circulatory status using the following parameters.
Blood pressure, heart rate. Ensure adequate perfusion to body and brain.
• Pass an intravenous catheter to provide fluid access
• Give adequate intravenous medications
• Determine and treat the underlying cause of the LOC