GCS of 2T vs 3T

[Big Z]

I have a question to throw out to the group:

I'm on a trauma surgery rotation, and during the morning report I presented a new patient that I admitted the night before. While presenting the patient's disability, I threw out that he was a GCS of 2T (intubated, no motor or eye opening). I was quickly quizzed, pimped, and berated in front of the group by the warm and fuzzy trauma surgeons, and was told that there is no such thing as a GCS of 2T.. that the worst score that you can get is a 3T. I was left feeling ashamed, confused, burned and quitely smoking in my chair.

I did an extensive internet search to find the answer, and found conflicting information.. some resources quoted the lowest score as being 2T, others 3T.. I also was taught that the lowest score was 3T while in medical school, but when I did the math (with the best score UNANIMOUSLY being 10T for the intubated patient), starting with 10T and counting down, I found the worst score possible to be a 2T!

What have you all been using, I'd love to get a consensus from everyone. Come on, help me with my Woody Allan moment (damn trauma surgeons)

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[USCDiver]

What's the lowest Motor score you can get? 1
What's the lowest Eye score you can get? 1
What's the lowest Verbal score you can get? 1

Add them up.... lowest score is 3. Adding the T just signifies that the patient is intubated and one shouldn't expect more than a 1 for Verbal. In other words a 10T is much different than a 10, but one could argue that a 3T is hardly better than 3.

 

[USCDiver]

Oh, that's what I was taught in medical school. Now I see that it doesn't make sense for 10T though, which I would think could be as high as 11T. Interesting.

 

[Big Z]

What's the lowest Motor score you can get? 1
What's the lowest Eye score you can get? 1
What's the lowest Verbal score you can get? 1

Add them up.... lowest score is 3. Adding the T just signifies that the patient is intubated and one shouldn't expect more than a 1 for Verbal. In other words a 10T is much different than a 10, but one could argue that a 3T is hardly better than 3.

But if 10T is the highest, then what you're doing is ELIMINATING the verbal score, and replacing it with the T ie: motor:6 eye movement:4.. 6+4=10T. Given your reasonsing, then why isn't the highest score an 11T?

Makes you think, huh?

 

[Seaglass]

Whatever the flaws in logic i was also taught that the lowest score is 3T and I 'm guessing that it's not going to change.

 

[A little elf]

The glascow coma scale was designed to evaluate people initially, not to follow them along over the course of days (I admit, I was guilty of this too on neurosurgery). Anyway, there is no such thing as a 2T (as previously stated). In fact, the only reason to give someone a numberT designation is if EMS already brings them in intubated. On second thought, forget what I'm trying to say because I'm a little intoxicated. Thank you.

 

[Medic13z]

Does anyone else feel like they are watching Spinal Tap...."these go to 11"

 

[ERMudPhud]

This just proves that using a research instrument like the GCS-designed to use neuro status on arrival to the ED as a prognostic instrument- as a clinical tool is a bit pointless. After all I once had a patient who blew his face off with a shotgun thus giving himself a potential maximum of 6T (No eyes to open so like the 0 he gets for verbal for being tubed I am giving him a 0 for eyes) and potential minimum of 1T or 3T depending on your point of view. However his 6T would imply a much better neuro status than a patient who gets 6 by getting 2 points in each catagory.

 

[docB]

This just proves that using a research instrument like the GCS-designed to use neuro status on arrival to the ED as a prognostic instrument- as a clinical tool is a bit pointless.

Plus the fact that I think everyone would know what you mean with either 2T or 3T. The people that raise a big stink about it are the same ones that argue incessantly about seizing vs seizuring and centimeters and sontameters.

 

[roja]

Its Toh-mah-to you embaciles!

 

[Apollyon]

centimeters and sontameters.

Seriously...what is up with that? I grew up in school with centimeters, and then, where the hell did the "sontameters" come from? Is everyone trying to be like the cool kids?

 

[Sessamoid]

Seriously...what is up with that? I grew up in school with centimeters, and then, where the hell did the "sontameters" come from? Is everyone trying to be like the cool kids?

I don't understand it. How do the Brits pronounce it? Because "Sont" sounds French, and if you're going to pronounce it as the French do, then get it right. "Centimetres" with the "s" silent.

 

[mikecwru]

Does anyone else feel like they are watching Spinal Tap...."these go to 11"

On a similar note, we had an MVA where they were arguing whether he was a 3 or a 4. My response was "I say, he's f*cked up," as I unsnapped the laryngoscope.

But then again, I guess you can't put that in the dictation.

mike

 

[docB]

I heard a lot of people gripe about the GCS because it's weird to have the lowest score be 3. Some would be happier if the lowest score were a 0. It is a little bit odd, even the dead and the gurney score a 3.

 

[DrQuinn]

I don't understand it. How do the Brits pronounce it? Because "Sont" sounds French, and if you're going to pronounce it as the French do, then get it right. "Centimetres" with the "s" silent.

I thought it was a DO thing. First year in med school we had these manipulation classes, and they kept saying "sontimeter." I raised my hand and asked what the hell a sontimeter was and they said it was a centimeter. Weird. All the DO professors who did manipulation used sont. I think since I graduated medical school I've heard an attending or two use it, though.
Q