Marino The ICU Book 4e, IE

810 Nervous System Disorders

Table 44.4

The Glasgow Coma Scale and Score

Points

Eye Opening: Spontaneous

4 3 2 1 5 4 3 2 1 6 5 4 3 2 1

To speech

To pain

❏ Points

None

Verbal Communication: Oriented Confused conversation

Inappropriate but recognizable words

Incomprehensible sounds

❏ Points

None

Motor Response: Obeys commands Localizes to pain Withdraws to pain

Abnormal flexion (decorticate response) Abnormal extension (decerebrate response)

❏ Points ❏ Points

No movement

Glasgow Coma Score (Total of 3 scales)*

*Worst score is 3 points, and best score is 15 points. With endotracheal intubation, the highest score is 11.

BRAIN DEATH The Uniform Determination of Death Act states the following: “An indi- vidual who has sustained either 1) irreversible cessation of circulatory and respiratory functions, or 2) irreversible cessation of all functions of the entire brain, including the brainstem, is dead.” (28). The second requirement in this statement is the purpose of the brain death determi- nation described here. Brain death is not a common consequence of the conditions listed in Figure 44.1, and is most often the result of traumatic brain injury and intracerebral hemorrhage, where increased intracranial pressure results in cessation of blood flow to all areas of the brain (29). Diagnosis A checklist for the diagnosis of brain death in adults is shown in Table 44.5 (30–32). There is a lack of consensus about minor aspects of the brain