How Endorsing the GCS Can Help You Save a Patient's Life

March 20, 2015 Phantasm Darkstar 0 Comment(s)

Being in a country where there is a nurse-patient ratio of 1:15-26 per shift, it is not easy to be able to perform a thorough assessment to all of the patients. In most cases, especially in a government setting, some assessments are skipped and only a few things are endorsed. In my experience among some institutions, the Glasgow Coma Scale or GCS is often missed because the assessment takes a while to finish, and only a few have actually memorized this scale by heart--some nurses also tend to focus more on the vital signs.

I was on ambulance duty when we responded to an 18-year old girl who lost consciousness at home. We assessed her vitals signs and gathered her medical history along with a brief physical assessment. She was diagnosed with chickenpox and is currently on her third day from when the symptoms started to appear. Although her vital signs are stable and within the normal range, I still assessed her GCS and had a score of 5 (E-3, V-1, M-1). We loaded her into the ambulance and I reassessed her during transport. I got a GCS of 4 (E-2, V-1, M-1) by the time that we arrived at the Emergency Room.

She was placed in an isolation area and I had to proceed to the doctors which were at the other side of the ER. I endorsed the patient to the them (I apologize if this was not done in front of the patient, this does not always happen, though. She was placed away from the medicine area because of her having varicella.), vital signs (stable), medical history, PA, and the GCS (4). Apparently, their reaction was unexpected. They laughed at me and told me that it is impossible for a chickenpox patient to end up having a GCS of 4. This could be a piss-off when you are serious and people would laugh at you at this moment. I stayed calm and explained to them, "Doc, we have no motor nor verbal response from the patient. She only opens her eyes to sternal rubbing and then closes her eyes again."

Upon hearing with what I said, one of the doctors rushed to the patient and started to sternal-rub her. This time, the patient was just at a blank stare but no response nor any eye movement--no blinking or anything (GCS 3). The doctor started to order a stat IVF and immediately called the medical tech and ordered for some laboratories and have the results sent to her stat. The staff attended to the patient and started performing their intervention.

In an emergency setting, the case of chickenpox is not classified as emergent in the triage system. It is a minor priority and the intervention can be delayed for hours. This is not the case for my patient. In spite of her stable vital signs, her GCS significantly dropped and may indicate a more serious problem. If I was not able to assess and endorse her GCS, or if I have not stood my ground and explained my score after the doctors laughed at me, who knows what could have happened to her.

Vital signs are critical in every assessment. However, we must always consider the neurologic status. There are things that we may be missing out for skipping the GCS assessment--just because
we have stable vital signs. Always remember that we are nurses and that we are the front liners of healthcare. Our clinical eye and thorough assessment is crucial in saving lives.

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