penilaian GCS pada anak

Paediatric Glasgow Coma Scale ChartName:

Date:

CHI Number:

Time:

PUPILS

Size (1-8) + reacts

- no reaction

c eye closed

Record right (r)

and left (l)

separately if

there is a

difference

between the

two sides.

Eyes closed by

swelling = C

Endotracheal

Tube or

Tracheostomy

= T

Usually record

best arrival

response.

Right Reaction

Left Reaction

Normal power

Normal power

Mild weakness

Mild weakness

Severe weakness

Severe weakness

Spontaneously

Obeys commands

Orientated

Spastic flexion

Spastic flexion

To speech

Localise pain

Confused

Extension

Extension

To pain

Withdrawal to pain

Inappropriate Words

No response

No response

None

Extension to pain

TOTAL COMA SCORE

None

None

Flexion to pain

Incomprehensible Sounds

Size (1-8)

FEATURE SCALE RESPONSE SCORE

Eye Opening Spontaneous 4 To voice 3 To pain 2 None 1

Verbal response Orientated/interacts/follows objects/smiles/alert/coos/babbles words to usual ability 5 Confused/consolable 4 Inappropriate words/moaning 3 Incomprehensible sounds/irritable/inconsolable 2 None 1

Best motor response Obeys commands/normal movement 6 Localise pain/withdraws to touch 5 Withdrawal to pain 4 Flexion to pain 3 Extension to pain 2 None 1

TOTAL COMA ‘SCORE’ 3/15 - 15/15

LI

MB

MOVEMENT

C

O

M

A

S

C

A

L

E

ARMS

LEGS

EYES

OPE

NBE

ST V

ERBA

L RE

SPO

NSE

BEST

MO

TOR

RESP

ON

SE

PupilScale(mm)

1 2 3 4 5 6 7 8

4

4

5

4

5

6

3

3

3

2

2

2

1

1

1

COmPLETE SCORES iN ShAdEd SECTiON