Anwendung | allgemein |
Anmerkung | siehe auch "revised trauma score" |
Respiratory rate [1] | 10-24 | 4 |
25-35 | 3 | |
>35 | 2 | |
<10 | 1 | |
0 | 0 | |
Respiratory effort [2] | Normal | 1 |
Shallow, or retractive | 0 | |
Systolic blood pressure [3] | >90 | 4 |
70-90 | 3 | |
50-69 | 2 | |
<50 | 1 | |
0 (no carotid pulse) | 0 | |
Capillary refill | Forehead, lip muscosa or nail . bed color refill in 2 sec | 2 |
More than 2 sec. of capillary refill | 1 | |
No capillary refill | 0 | |
Glasgow Coma Scale [4] | ||
Eye opening | Spontaneous | 4 |
To voice | 3 | |
To pain | 2 | |
None | 1 | |
Verbal response | Oriented | 5 |
Confused | 4 | |
Inappropriate words | 3 | |
Incomprehensible words | 2 | |
None | 1 | |
Motor response | Obeys commands | 6 |
Purposeful movement (pain) | 5 | |
Withdraw (pain) | 4 | |
Flexion (pain) | 3 | |
Extension (pain) | 2 | |
None | 1 | |
Total GCS | 14- 15 | 5 |
11 -13 | 4 | |
8-10 | 3 | |
5-7 | 2 | |
3-4 | 1 | |
Result | Trauma Score = total points (alle fettgedruckten Kategorien) |
[1] Number of respirations per minute |
[2] Shallow - markedly decreased chest movement or air exchange. Retractive - use of accessory muscles or intercostal retraction |
[3] Systolic cuff pressure - either arm - auscultate or palpate |
[4] Teadsdale G, Jennett B (1974) Assessment of coma and impaired consciousness - a practical scale. Lancet II: 81-83 |