GCS, Motor grade, EICU 특징 및 평가 방법

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1. Glasgow Coma Scale (GCS)

GCS는 의식 상태를 사정하는 도구로 눈뜨기 기능(4점), 언어 기능(5점), 운동 기능(6점)의 3가지 세부 항목 합산으로 뇌 손상 정도를 파악합니다. 총 15점 만점이며, GCS < 9는 중증 두부손상, 9~12는 중등도, ≥13은 경미한 손상으로 분류됩니다. 점수를 의식 수준(LOC)으로 정리하면 15점은 Alert, 13~14점은 Drowsy, 8~12점은 Stupor, 4~7점은 Semi-Coma, 3점 이하는 Coma입니다.
2. Motor Grade (근력 평가)

환자의 근력을 평가하는 도구로 근력 변화, 신경 손상, 척추 질환, 뇌질환 후 회복 상태를 평가합니다. Grade 5는 정상 근력, Grade 4는 중력과 약간의 저항에 대해 관절 범위 운동 가능, Grade 3은 중력에 거슬러 움직임 가능, Grade 2는 중력에 거슬러 움직일 수 없으나 수평적 움직임 있음, Grade 1은 약간의 근육 수축만 있고, Grade 0은 마비 상태입니다. 상지(UE)와 하지(LE)를 각각 기록합니다.
3. Emergency Intensive Care Unit (EICU)

응급중환자실은 응급실을 통한 입원이 많으며 K-TAS 3등급 이상이어야 입실 가능합니다. 급성 질병, 만성질병의 급성 증상 발현, 외상 환자가 주를 이루며 3~5일 후 중환자실로 이동합니다. 현재 환자들은 septic shock, ARDS, ESRD, AKI, 폐렴, 척추손상 등으로 신장내과, 호흡기알레르기내과, 일반외과 환자가 주를 이루고 있으며 CRRT, Ventilator, Tracheostomy 등의 치료를 시행합니다.

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1. Glasgow Coma Scale (GCS)

The Glasgow Coma Scale is a fundamental and invaluable tool in clinical practice for assessing consciousness levels in patients with acute neurological conditions. Its simplicity and objectivity make it universally applicable across different healthcare settings, from emergency departments to intensive care units. The three-component assessment—eye opening, verbal response, and motor response—provides a standardized method that enables consistent communication among healthcare professionals regarding patient neurological status. However, it's important to recognize its limitations: GCS may be affected by factors such as sedation, intubation, and language barriers, which can compromise accuracy. Despite these constraints, the scale remains essential for initial triage, monitoring disease progression, and predicting outcomes in traumatic brain injury and other neurological emergencies. Regular training and standardized application protocols are crucial to minimize inter-observer variability and ensure reliable clinical decision-making.
2. Motor Grade (근력 평가)

Motor grading systems are critical components of neurological examination that provide objective quantification of muscle strength and functional capacity. The standard 0-5 scale offers a practical framework for detecting weakness, monitoring recovery, and identifying neurological deterioration. Motor assessment is particularly valuable in evaluating patients with stroke, spinal cord injury, peripheral nerve damage, and neuromuscular disorders. The strength of motor grading lies in its reproducibility and ability to track changes over time, facilitating evidence-based treatment decisions. Nevertheless, subjective interpretation remains a challenge, as grading depends on patient cooperation, effort, and examiner experience. Additionally, the scale may not adequately capture subtle weakness or functional limitations in daily activities. Complementary assessments such as functional testing and imaging studies are often necessary for comprehensive evaluation. Proper training and standardization of examination techniques are essential to improve reliability and clinical utility of motor grading in patient management.
3. Emergency Intensive Care Unit (EICU)

The Emergency Intensive Care Unit represents a critical evolution in acute care delivery, bridging the gap between emergency departments and traditional ICUs by providing immediate intensive monitoring and intervention for severely ill patients. EICUs enhance patient outcomes through rapid access to advanced life support, specialized equipment, and experienced critical care teams during the crucial early hours of acute illness. This model is particularly effective for managing sepsis, acute respiratory failure, severe trauma, and cardiogenic shock where time-sensitive interventions significantly impact survival. The concentrated expertise and resources in EICUs enable faster diagnostic procedures and therapeutic interventions compared to general ward settings. However, establishing and maintaining EICUs requires substantial financial investment, specialized staffing, and infrastructure. Additionally, the effectiveness of EICUs depends heavily on appropriate patient selection and referral protocols to avoid unnecessary resource utilization. When properly implemented with clear admission criteria and integrated care pathways, EICUs demonstrate significant potential in reducing mortality and morbidity in critically ill patients during their most vulnerable period.