Marino The ICU Book 4e, IE


Disorders of Consciousness

Brainstem Intact

Brainstem Not Intact

Oculocephalic Reflex



Oculovestibular Reflex



FIGURE 44.3 The ocular reflexes in the evaluation of coma.

2. To stratify the severity of head injury (mild: GCS = 13 – 15, moder- ate: GCS = 9 – 12, severe: GCS ≤ 8 ) (25,26). 3. To identify candidates for intubation; i.e., airway protective reflexes are typically defective at a GCS ≤ 8, which is used as an indication for endotracheal intubation. 4. As a prognostic marker; e.g., in the initial evaluation of nontraumat- ic coma, patients with a GCS ≥ 6 are seven-times more likely to awaken within two weeks than patients with a GCS ≤ 5 (27). 5. The influence of induced hypothermia on the prognostic value of the GCS is described in Chapter 17 (see Table 17.5). INTUBATED PATIENTS: One of the major shortcomings of the Glasgow Coma Scale is the inability to evaluate verbal responses in intubated patients. These patients are assigned a verbal pseudoscore of 1 (for a maximum GCS of 11).

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