About the ads

GCS of 2T vs 3T

Discussion in 'Emergency Medicine' started by Big Z, Aug 24, 2004.

  1. SDN is a nonprofit organization. Services are made possible through the generous support of SDN members and sponsors. Thank you.
?

What's the lowest possible GCS for the intubated patient?

Poll closed Sep 7, 2004.
  1. GCS 2T

    6 vote(s)
    18.8%
  2. GCS 3T

    26 vote(s)
    81.3%
  1. Big Z

    Big Z

    Joined:
    Feb 18, 2004
    Messages:
    28
    Location:
    Delaware
    Status:
    Attending Physician
    SDN 7+ Year Member

    SDN Members don't see this ad. (About Ads)
    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)

    :smuggrin: :smuggrin: :smuggrin:
  2. USCDiver

    USCDiver Percocet-R-US

    Joined:
    Aug 31, 2003
    Messages:
    449
    Location:
    Greensboro,NC
    Status:
    Attending Physician
    SDN 10+ Year Member
    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.
  3. USCDiver

    USCDiver Percocet-R-US

    Joined:
    Aug 31, 2003
    Messages:
    449
    Location:
    Greensboro,NC
    Status:
    Attending Physician
    SDN 10+ Year Member
    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.
  4. Big Z

    Big Z

    Joined:
    Feb 18, 2004
    Messages:
    28
    Location:
    Delaware
    Status:
    Attending Physician
    SDN 7+ Year Member
    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?
  5. Seaglass

    Seaglass Quantum Member

    Joined:
    Jul 25, 2003
    Messages:
    1,614
    Location:
    Winston Salem, NC
    Status:
    Attending Physician
    SDN 7+ Year Member
    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.
  6. A little elf

    A little elf Member

    Joined:
    Jun 6, 2001
    Messages:
    71
    Location:
    midwest
    SDN 7+ Year Member
    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.
  7. Medic13z

    Medic13z I drink because you cry

    Joined:
    May 29, 2002
    Messages:
    56
    Location:
    The Rat Trap
    SDN 7+ Year Member
    Does anyone else feel like they are watching Spinal Tap...."these go to 11"
  8. ERMudPhud

    ERMudPhud Back for a visit

    Joined:
    Feb 24, 2003
    Messages:
    1,081
    SDN 7+ Year Member
    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.
  9. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

    Joined:
    Nov 27, 2002
    Messages:
    7,735
    Location:
    Las Vegas, NV
    Status:
    Attending Physician
    Physician SDN Published Author SDN 10+ Year Member
    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.
  10. roja

    roja

    Joined:
    Oct 20, 2003
    Messages:
    6,044
    Location:
    NYC--->San Francisco
    Status:
    Attending Physician
    SDN 7+ Year Member
    Its Toh-mah-to you embaciles!
  11. Apollyon

    Apollyon Screw the GST Lifetime Donor

    Joined:
    Nov 24, 2002
    Messages:
    16,313
    Location:
    SCREW IT!
    Physician SDN 10+ Year Member
    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?
  12. Sessamoid

    Sessamoid 1K Member

    Joined:
    Sep 11, 2003
    Messages:
    1,656
    Location:
    Los Angeles
    SDN 7+ Year Member
    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.
  13. mikecwru

    mikecwru M.D. = Massive Debt

    Joined:
    Oct 21, 2002
    Messages:
    948
    Location:
    Ohio
    Status:
    Attending Physician
    SDN 7+ Year Member
    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
  14. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

    Joined:
    Nov 27, 2002
    Messages:
    7,735
    Location:
    Las Vegas, NV
    Status:
    Attending Physician
    Physician SDN Published Author SDN 10+ Year Member
    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.
  15. DrQuinn

    DrQuinn My name is Neo Moderator Emeritus

    Joined:
    Dec 6, 2000
    Messages:
    4,224
    Location:
    Wisconsin
    SDN 10+ Year Member
    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

Share This Page


About the ads