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Thursday, September 19, 2019

CRITICAL CARE SCORING..EVERY NURSES TO KNOW


The commonly used trauma and critical care scores are briefly discussed below.

GLASGOW COMA SCORE

The Glasgow Coma Score (GCS) judges the extent of coma in
patients with head injury. It is useful for pre-hospital trauma
triage as also for patient assessment after hospitalization. The
scale is based on eye opening, motor response and verbal
response  and can be tested and scored by the
physician within a couple of minutes. The total score is the
sum of each response and varies from a minimum of 3 to a
maximum of 15. The lower the score the greater the severity
of head injury in relation to central nervous system (CNS)
function.

 Glasgow Coma Scale

Eye opening

4 = Spontaneous
3 = To voice
2 = To pain
1 = None

Motor response

6 = Obedient
5 = Purposeful
4 = Withdrawal
3 = Flexion
2 = Extension
1 = None

Verbal response

5 = Oriented
4 = Confused
3 = Inappropriate
2 = Incomprehensible
1 = None

TRAUMA SCORE AND REVARSESD TROUMA SCORE

These are useful for patients with trauma. The trauma score
is based on the state of the cardiovascular and respiratory
systems and on the GCS . Values are given to each
parameter and these are added to give the total trauma score,
which ranges from 1 to 16. The lower the score the greater the
risk for mortality.
The trauma score was found to underestimate the prognostic significance of head injuries. This led to the development of the revised trauma score (RTS), which is
now widely used to assess the severity of trauma. The RTS
is based on the GCS, the systolic blood pressure (SBP) and
the respiratory rate. Coded values are given for the above
parameters and summed up . Higher values have a
better prognosis and lower values a poor prognosis.

TROUMA SCORE


A..Systolic blood pressure

>90      - 4
70–90  - 3
50–69  - 2
<50      - 1
0          - 0

B. Respiratory rate

10–24  4
25–35  3
>35      2
<10      1
0          0

C..Respiratory effort

Normal       -  1

Shallow or
retractions  - 0

D. Capillary refill

Normal  - 2
Delay     - 1
None     - 0

E. Glasgow Coma Scale

1. Eye opening

4 = Spontaneous
3 = To voice
2 = To pain
1 = None

2. Motor response

6 = Obedient
5 = Purposeful
4 = Withdrawal
3 = Flexion
2 = Extension
1 = None

3. Verbal response

5 = Oriented
4 = Confused
3 = Inappropriate
2 = Incomprehensible
1 = None

(1 + 2 + 3)
14–15 - 5
11–13 - 4
8–10   - 3
5–7     - 2
3–4     - 1
Trauma score (A + B + C + D + E) = _________


REVERSED TROUMA SCORE


CRAMS SCALE

The circulation, respiration, abdomen, motor, speech 
(CRAMS) scale is another trauma triage scale frequently used to decide which patients require urgent admission to a trauma unit. Patients with a low CRAMS score need urgent critical care.


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