Disability

• determine Glasgow Coma Scale (GCS, see Table 8—2)

• GCS <8 suggests severe head injury; 9—12 moderate head injury, >13 mild head injury

TABLE 8

1—1. Hemorrhage classes

Class

Loss of Blood

Symptoms

Treatment

Class I

10% (500 cc)

asymptomatic

maintain urine output of 30—60 cc/hour

Class II

20% (1000 cc)

mildly anxious, narrowed pulse pressure

replace blood loss with crystalloid fluids (3X estimated blood loss)

Class III

30-40% (1500-1700 cc)

tachycardia, diaphoresis, hypotension, confusion

rapidly bolus with crystalloid fluids, replace blood loss with packed red blood cells

Class IV

>40%

lethargy, coma, tachycardia, diaphoresis, hypotension

rapidly bolus with crystalloid fluids, replace blood loss with packed red blood cells, address acid/base/electrolytes

TABLE 8-2. Glasg.

ow Coma Scale (GCS)

Response

Score

Eye Opening

spontaneous

4

responds to speech

3

responds to pain

2

no eye opening

1

Verbal Response

oriented

5

confused

4

inappropriate

3

incomprehensible sounds

2

none

1

Motor Response

moves to command

6

localizes to pain

5

withdrawals from pain

4

decorticate posturing (flexion)

3

decerebrate posturing (extension)

2

no movement

1

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