Emergency Medicine

30 Critical Care Emergencies

SEVERE HEAD INJURY

Table 1.1 The Glasgow Coma Scale (GCS) score

Score

Eye opening Spontaneously 4

To speech 3

To pain 2

None 1

Verbal response Oriented 5

Confused 4

Inappropriate 3

Incomprehensible 2

None 1

Motor response Obeys commands 6

Localizes pain 5

Withdraws (pain) 4

Flexion (pain) 3

Extension (pain) 2

None 1

(i) A patient in coma has a score of 8 or less.

(ii) A decrease in score of 2 or more points indicates a significant

deterioration.

(iii) Repeat neurological examinations, including the GCS, are

essential for detecting and managing secondary brain damage.

6 Insert a large-bore i.v. cannula and send blood for FBC, U&Es, coagulation

profile, blood sugar, and G&S, and save serum for a drug screen in case

a lcohol or drug intoxication is subsequent ly suspected.

7 Send ABGs, recording the percentage of inspired oxygen administered at the

time the sample was drawn.

8 Perform a neurological examination, including:

(i) Conscious level: regularly record the GCS and look for any

deterioration (decrease in score).

(ii) Pupil size and reactions: look in particular for an unequal

or dilating pupil, indicating a focal mass lesion and or rising

intracranial pressure.

The maximum score is 15. Any reduction in score indicates deterioration in the level of

consciousness.