GCS评分解读2014版.ppt

GlasgowComaScale,=上海德济医院ICU王颖,GlasgowComaScale,定义：TheGCSprovidesapracticalmethodforassessmentofimpairmentof(1)consciouslevelinresponseto(2)definedstimuli.用途：Thefindingsusingthescale(3)guideinitialdecisionmakingand(4)monitortrendsinresponsivenessthatareimportantinsignallingtheneedfornewactions.(5)FAQ,1.ConsciousLevel,NormalConsciouslevel:Eyeopening-spontaneous自主睁眼Verbalresponse-oriented回答切题Motorresponse-obeycommands遵嘱动作,2.Definedstimuli,Astructuredassessment结构性的评估体系Itsetsoutstandardisationinstimulationandanemphasisonreportingofthethreecomponentsratherthanthetotalsum.制定了标准的检查（刺激）方法，相比GCS总分，更强调3个评估项目各自的重要性。,2.Definedstimuli,StructuredAssessment：Check-Observe-Stimuli-Rate参见PDF表格睁眼刺激：指甲按压运动刺激：斜方肌刺激眶上缘刺激,3.guideinitialdecisionmaking,气管插管手术探查,4.monitortrendsinresponsiveness,WhenandhowoftenshouldObservationsberecorded?Frequencyofobservation每隔30分钟记录一次，直到GCS=15分。GCS=15后，每30分钟记录1次X4次，续每1小时记录1次X4次，续每2小时1次。GCS=15，一旦病情恶化，评分下降，重新开始每30分记录一次。Urgentreappraisalbythesupervisingdoctor总分降低1分，持续超过30分钟，尤其是M。E或者V降低超过3分，或者M降低超过2分。,RecordingGCS,FAQ,WhatfactorscaninterferewithassessmentoftheGlasgowComaScaleandwhatcanbedoneaboutthem?干扰GCS评分的常见原因？怎么做？WhatisthereliabilityoftheScale?Howisitoptimised?IstheGlasgowComaScaleonlyforuseinHeadInjuries?GCS评分只适用于颅脑外伤吗？Howmuchchangeisimportant?,干扰GCS评分的常见原因？怎么做？,Pre-existingfactorsLanguageorculturaldifferences+Intellectualorneurologicaldeficit+HearinglossorspeechimpedimentEffectsofcurrenttreatmentPubationortracheostomy+Pharmacologicale.g.sedationorparalysisEffectsofotherinjuriesorlesionsOrbital/Cranialfracture+DysphasiaorHemiplegia+Spinalcorddamage,干扰GCS评分的常见原因？怎么做？,Pre-existingfactorsLanguageorcultural+Intellectualorneurological+Hearinglossorspeechimpediment=writtencommunicationEffectsofcurrenttreatmentPubationortracheostomy+Pharmacologicale.g.sedationorparalysis=NTnontestableWakeuptestEffectsofotherinjuriesorlesionsOrbital/Cranialfracture+DysphasiaorHemiplegia+Spinalcorddamage=检查舌头及眼球运动,干扰GCS评分的常见原因？怎么做？,Dealingwithmissinginformation:Assess,communicateandmakedecisionsusingtheremainingcomponents.AlthoughguidelinesareoftenexpressedintermsofatotalGCSscore,thetrendinwhicheverofthecomponents(eye,motororverbal)canbeassessedisstillvaluable.Donotusenumber1torecordmissingcomponent;useNT(Nottestable).DonotreportatotalscorewhenacomponentisNotTestablebecausethescorewillbelowandthiscouldbeconfusingtomedicalcolleagues.Thismayalsoimplythatthepatientismoreunwellthantheyactuallyare.Itispossibleusingstatisticalmethodstoestimateamissingcomponentfromthefindingsintheothercomponents.Thisisprobablymorerelevanttoresearchthanclinicalpractice.,WhatisthereliabilityoftheScale?Howisitoptimised?,reducereliability:thewaythatmissinginformationisdealtwith.enhancereliability:theextentoftrainingandexperienceoftheexaminer.=-newstructuredapproach-definedcriteria-,评分只适用于颅脑外伤吗？,NO.impairmentofconsciousnessfroma