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sF.Fkv.F³.F.kn.kn. ]cnioe\ ]cn]mSn
Glasgow Coma Scale : English – Malayalam Version
¥mkvtKm tIma kvsIbn þ aebmf ]cn`mj
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Glasgow Coma Scale : Malayalam
Translation
¥mkvtKm tIma ØíæµÏßW : aebmf ]cn`mj
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What all we will learn
\½Ä Fs´Ãmw ]Tnçw
1. What is “GCS”?
2. What are its components?
3. How do we assess each
component?
4. When is GCS used ?
1. F´mWv “Pn.kn.Fkv”?
2. Fs´ÃmamWv CXnsâ
LSI§Ä?
3. F§s\bmWv \½Ä
CXnsâ Hmtcm LSIhpw
\nÀ®bnç¶Xv?
4. Ft¸mgmWv Pn.kn.Fkv.
D]tbmKnç¶Xv?
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Glasgow Coma Scale (G C S):
¥mkvtKm tIma ØíæµÏßW (Pn.kn.Fkv):
•
GCS is a neurological scale
•
It provides an objective way of
recording the conscious state of a
person
•
It can be used for initial
assessment as well as
subsequent assessment
• Pn.kn.Fkv. F¶Xv
\mUnhyhØbpsS
{]hÀ¯\s¯ Af¡mëÅ
Hê am\ZÞamWv.
• Hê hyànbpsS
t_m[mhØsb ædn¨pÅ
hkvXp\njvTamb Hê Nn{Xw
CXp \Âæì.
• {]mYanI hnebnê¯enëw
XpSÀ hnebnê¯enëw CXp
D]tbmKn¡mhp¶XmWv.
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Glasgow Coma Scale (G C S):
¥mkvtKm tIma ØíæµÏßW (Pn.kn.Fkv):
1974-- þÂ
The scale was published in 1974
by
Graham Teasdale &
Bryan J. Jennett,
Professors of Neurosurgery
University of Glasgow
¥mkvtKm kÀhIemimebnse
\|tdm kÀPdn hn`mKw
{]^kÀamcmb
{Klmw SokvtUÂ,
{_bm³.sP.sP¶äv
F¶nhcmWv Cu kvsIbenëv
cq]w \ÂInbXv
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Elements of G C S:
Pn.kn.Fknsâ LSI§Ä:
•
G C S is composed of three
components :
– Eye response
– Verbal response
– Motor response
•
Each of these components further
have scores
• Pn.kn.Fknëv aq¶ v
LSI§fméÅXv : - --- -t\{X-- {]XnIcWw
--- i_vZ {]XnIcWw
- --- Ne\ {]XnIcWw
• Cu Hmtcm LSI¯nëw
\nÝnXamb kvtImdpIÄ
\ÂIs¸«ncnçì
Let’s see what are the sub-components
Cu Hmtcm LSIhpw F´mWv F¶vv \apç ]cntim[n¡mw-ISNACC Training Program
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Eye response (E) : 4 score
t\{X {]XnIcWw (C): 4 kvtImÀ
There are four points. Starting with the
‘best’ to the ‘most severe’, they are:
•
Eyes opening spontaneously
(4 points)
•
•
Eye opening to speech (3 points)
•
•
Eye opening in response to pain
•
stimulus (2 points)
•
No eye opening (1 point)
•
H¶v apXÂ \mep hscbmWv CXnsâ
t]mbnâpIÄ.
Cu t]mbnâpIÄ ‘hftc \ÃXnÂ’
XpS§n ‘Gähpw Xo{hambXnsâ’
ASnØm\¯nemWv
{Ias¸Sp¯nbncnç¶Xp.
kzbta I®pIÄ Xpdçì
(4 t]mbnâkvv)
Õß{ßAáçOÞZ µHáµZ ÄáùAáKá
(3 t]mbnâkvv)
çÕÆÈ ÈWµáçOÞZ µHáµZ
ÄáùAáKá (2 t]mbnâkvv)
µHáµZ ÄáùAáKçÄÏßÜï
(1 t]mbnâ v)
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How we check Eye Response to pain
çÕÆÈ ÈWµáçOÞZ ©U t\{X {]XnIcWw
®BæÈ ÉøßçÖÞÇßAÞ¢
“çÕÆÈ ÈWµáKÄßÈáU ÎÞVPBZ”:
“Pain stimulus”:
1.
Nail bed pressure
2.
Interdigital pressure
3.
Supraorbital Pressure
4.
Sternal Rub
1.
2.
3.
4.
(See next slide for demonstration)
ȶJßæa ºáÕGßW ¥ÎVJáµ
ÕßøÜáµÜáæ¿ §¿ÏßW çÉÈçÏÞ
æÉXØßçÜÞ æÕºîí çºVJí ¥ÎVJáµ.
µYÉáøßµJßÈá Îáµ{ßÜÞÏß ¥ÎVJáµ
s\©nsâ ÎáX ÍÞ·JÞÏß ¥ÎVJáµ
(æºçÏîI ÕßÇ¢ ¥¿áJ èØïÁßW
µÞÃÞÕáKÄÞÃí )
Caution : Painful stimulation should be minimal needed to elicit the response.
dÖißçAIÄí: dÉÄßµøâ ©{ÕÞAáKÄßÈáU ¯xÕᢠºáøáBßÏ çÕÆÈ am{Xta
ÈWµÞÕâ
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How we check Eye Response : pictures
t\{X {]XnIcWw ®BæÈ ÉøßçÖÞÇßAÞ¢ : ºßdÄBZ
Interdigital pressure
ÕßøÜáµÜáæ¿ §¿ÏßW
çÉÈçÏÞ æÉXØßçÜÞ
æÕºîí çºVJí
¥ÎVJáµ.
Nail bed pressure
ȶJßæa ºáÕGßW
¥ÎVJáµ
Supraorbital Pressure
Sternal Rub
µYÉáøßµJßÈá
Îáµ{ßÜÞÏß
¥ÎVJáµ
s\©nsâ ÎáX
ÍÞ·JÞÏß
¥ÎVJáµ
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Verbal response (V): 5 scores
i_vZ {]XnIcWw(hn) :5 kvtImÀkv
H¶v apXÂ A©v hscbmWv CXnsâ
t]mbnâpIÄ.
There are five points. Starting with the
‘best’ to the ‘most severe’, They are:
•
Oriented (5points)
•
•
Confused (4 points)
•
Inappropriate speech (3 points)
•
•
•
Incomprehensible speech (2 points)
•
•
None (1 points)
•
Cu t]mbnâpIÄ ‘hftc \ÃXnÂ’
XpS§n ‘Gähpw Xo{hambXnsâ’
ASnØm\¯nemWv
{Ias¸Sp¯nbncnç¶Xp.
]p˨ambpw kzm`mhnIamb kwkmcw
(5 t]mbnâkvv)
Aåw ægª kwkmcw (4 t]mbnâkvv)
]ckv]c _ÔanÃmsXbpÅ kwkmcw
(3 t]mbnâkvv)
XoÀ¯pw a\Ênem¡m³ Ignbm¯
kwkmcw. (2 t]mbnâkvv)
Hê iÐhpw ]pds¸Sphn¡m¯ AhØ
(1 t]mbnâ v)
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Motor response (M): 6 scores
Ne\ {]XnIcWw(Fw): 6 kvtImÀkv
There are six points. Starting with the
‘best’ to the ‘most severe’, they are:
•
Obeying commands (6 points)
•
•
Localizing response to pain (5 points)
•
•
Withdraws to pain (4points)
•
•
Abnormal flexor response (3 points)
(See next slide)
Extensor posturing to pain (2 points)
(See next slide)
•
•
•
H¶v apXÂ Bdp hscbmWv CXnsâ
t]mbnâpIÄ.
Cu t]mbnâpIÄ ‘hftc \ÃXnÂ’ XpS§n
‘Gähpw Xo{hambXnsâ’ ASnØm\¯nemWv
{Ias¸Sp¯nbncnç¶Xp.
\nÀt±i§Ä IrXyambn Aëkcnçì
(6 t]mbnâkvv)
thZ\ \Âæ¶ Øew Xncn¨dnbpì. (5
t]mbnâkvv)
thZ\ \Âæ¶ Øew ]n³hençì
(4 t]mbnâkvv)
Akm[mcWamb coXnbnepÅ ssI/ImÂ
aS¡Â. (3 t]mbnâkvv)
(¥¿áJ èØïÁßW IméI)
•
No response to pain (1 point)
Akm[mcWamb coXnbnepÅ ssI/ImÂ
\nhÀ¯Â (2 t]mbnâkvv)
(¥¿áJ èØïÁßW IméI)
•
thZ\tbmSv bmsXmê {]XnIcWhpanÃm¯
AhØ (1 t]mbnâ v)
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Posture :
icoc¯nsâ AhØ:
Extension Posturing
Akm[mcWamb coXnbnepÅ
ssI/Im \nhÀ¯Â.
Abnormal Flexion
Akm[mcWamb coXnbnepÅ
ssI/Im aS¡Â.
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Maximum & Minimum GCS Scores
IqSnbXpw ædªXpamb Pn.kn.Fkv. kvtImÀkv
•
Maximum score : E4V5M6 : 15 (Fully conscious patient)
•
Minimum score : E1V1M1 : 3 (Deeply comatosed )
•
Gähpw IqSnb kvtImÀ: (C)4 (hn)5 (Fw)6: 15 (]qÀ®t_m[mhØ)
•
Gähpw ædª kvtImÀ (C)1 (hn)1 (Fw)1: 3 (]qÀ®At_m[mhØ)
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When is GCS used ?
Ft¸mgmWv Pn.kn.Fkv. D]tbmKnç¶Xv?
•
Traumatic Brain Injury
•
Poisoning
•
As part of ICU scoring
system
•
akvXnjvI¯në £XtaähÀ.
•
hnjw DÅn sN¶hÀ.
•
Xo{h]cnNcW hn`mK¯nse
tcmKnIÄ¡mbn DÅ
kvtImdn§v
kwhn[m\¯nsâ
`mKambn«v.
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Why is GCS important ?
F´mWv Pn.kn.Fknsâ {]m[m\yw?
• It informs about the
prognosis of the
patient.
• Fall in GCS means
deterioration
• Rise in GCS means
improvement
• tcmK hnapànbpsS
km[yXIÄ Xncn¨dnbm³
klmbnçì.
• kvtImÀ ædbp¶Xp tcmKn
tamiamæ¶Xnsâ
kqN\IfmWv.
• kvtImÀ IqSp¶Xp tcmKn
sa¨s¸Sp¶Xnsâbpw
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Severity assessment by GCS
Pn.kn.Fkv. D]tbmKn¨v tcmK Xo{hX \nÀ®bnç¶ coXn.
SEVERE :
IqSnb Xo{hX
3-8
MODERATE :
MILD
9-12
13-15
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CS¯cw Xo{hX
sNdnb Xo{hX
16
How often one should check for G C S ?
Ft¸msgÃmamWv tcmKnbpsS Pn.kn.Fkv.
ÈßVHÏßçAIÄí?
• Bip]{XnbnÂ
• Immediately on
AUvanämbpSs\
admission.
• XpSÀ \nÀ®bw
• Subsequent assessment
tcmKXo{hXsb
depends upon the
B{ibn¨ncnçì.
seriousness of the patient
– More serious, assess more
frequently
- -- AXoh KpêXcmhØbnepÅhÀç
IqsS IqsS çÈÞçAIÄÞÃí.
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Glasgow Coma Scale : English-Malayalam Translation
¥mkvtKm tIma kvsIbn þ aebmf ]cn`mj
Compiled for ISNACC
Translation team :
• Dr. Varun.S.
• Dr. Priya.P.
sF.Fkv.F³.F.kn.knþç
çÕIß
X¿mdm¡nbXv
tUm. hê¬.Fkv.
tUm. {]nb. ]n.
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