2 Drooping upper eyelid when eyes are open (ptosis).
3 One pupil dilated and fixed.
4 Both pupils dilated and fixed.
JUDGING LEVEL OF SEVERITY OF HEAD INJURY
The most important indication of the severity of a patient's head injury is the
patient's level of consciousness. His initial level of consciousness is also the best
indicator of how well the patient will recover from the head injury. A changed level of
consciousness reflects the degree of generalized injury to the brain. Initially, the
patient's level of consciousness can be assessed by testing his responses to stimuli
using the AVPU test.
a. A - Is the patient alert? Is the patient looking around to find out where he is?
b. V - Does the patient respond to verbal stimuli? When asked a question,
does the patient respond well or at all?
c. P - Does the patient respond to painful stimuli? Does the patient respond to
a pinch or a pin prick?
d. U - Is the patient unresponsive? Does the patient respond to no stimuli at
LEVELS OF HEAD INJURY
a. The Glasgow Coma Scale. The Glasgow Coma Scale (GCS) is the most
widely used system of defining the level of consciousness of head-injured patients.
Older classification systems relied on descriptive terms such as obtundation (diminished
pain or touch sensations), stupor, semicoma, etc. These terms sometimes meant
different signs/symptoms to different people. The Glasgow Coma Scale defines the
level of consciousness according to three functions: eye-opening, language function
(verbal response), and movement (motor response).
b. Responses of Glasgow Coma Scale. Each of these functions has a set of
subscales made up of a hierarchy of responses which are assigned numerical values
(points). The patient is stimulated, his response is observed, and a point value is given
based on the response. The person examining the patient tries to draw out the best
response from the patient. The total number of points from these patient responses
defines a level of consciousness (recognized worldwide) and indicates the severity of
the head injury.