Want to remember a quick and easy trick for remembering the Glasgow Coma Scale?
My Extra Value Meal costs $4.56
– Eyes: 1-4
– Verbal 1-5
– Motor 1-6
You can always remember the top numbers of the scale by using this mnemonic, whether or not you actually remember the details of the numbers in the middle. If you remember the top numbers, you should also remember that the numbers don’t go down to 0 on any of the individual scales, they only go down to 1. This means that while the Statue of Liberty is a 6 on the Glasgow Coma Scale, a carrot is a â€œ3â€³ as are many members of congress and most people who reside in cemeteries unless there happens to be a coinciding zombie apocalypse at the time you’re checking my facts. A person that opens their eyes and speaks normally to you when you say Howdy! to them has a score of 15, provided they’re able to move around pretty good when ya poke em.
Admittedly, I don’t use the Glasgow all that much in my paramedic practice. I’ve never found much use for it when I’m in the heat of the moment with a patient of questionable responsiveness and I loathe that old piece of EMS dogma that tells us Less than 8? Intubate! because that’s just silly nonsense that has managed to remain in our consciousness because it rhymes. As the scale goes, there are plenty of patients who I would happily not intubate should they have a Glasgow of 7 and many patients at a 9 who might be in need of interventional airway management. It’s very relative and a clinician should never use the Glasgow Coma Scale as their sole motivation for shoving a piece of plastic down someone’s throat. The score can be part of your decision making process, and is quite handy as a documentation tool when you’re writing your patient care report, but you need to let go of the Less then 8 intubation hogwash, no matter how well it rhymes.
As I get older, there are plenty of times when I get up for night ambulance calls where I don’t hit a Glasgow score of 15 for at least 20 minutes or so. I’m certainly under an 8 when I’m sleeping (Eyes 2 or 3, Verbal 1, 2, or 3 depending on the quality of my dreams, and Motor is hopefully at least a 4), and after the tones go off, I may hit an Eyes of 4 right away, or might close them again and require the dispatcher to start the second tone before I open them again, giving me a 3. My verbal response is usually a groan, depending on the nature of the call and the quality of my previous sleeping, so you might still be able to give me a 2 or 3 until after I’ve been driving or on scene for a while. I certainly don’t reach a V of 5 for at least a few solid minutes. My Motor score is usually a 5 or 6 but I can move pretty quickly depending on how badly I have to pee when I’m woken up and still have to make it out the door in under 2 minutes.
There are probably plenty of people who would tell me that the Glasgow Coma Scale is a great tool and that if I’m not finding it useful, it’s because I’m not trying hard enough. That might be fair. I’ll give it its place as a useful tool for EMS documentation and as a very nice test question for EMS classes. Learning how to properly score a Glasgow Coma Scale is also a good tool for teaching EMS people how to systematically evaluate patients who are obtunded and who may be going down the tubes. The individual numbers within the E, V, and M boxes usually degrade and improve in the order they’re scored and as such, learning the Glasgow Scale is a great way of teaching new EMS providers how to think about altered levels of consciousness. It teaches a mindset, and that is valuable, just as it is with the AVPU scale where patients fall from Alert to Unresponsive hitting the Verbal and Painful responses on the way down.
Remember that your Extra Value Meal costs $4.56 and you’ve got this Glasgow thing down. Free yourself of the dogma that some number on the scale means the patient must mandatorily be intubated, and use the scale as a piece of your clinical decision making and you’re doing well.
Be safe out there.