Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Coma is a state of unconsciousness whereby a patient cannot react with the
surrounding environment. The patient cannot be wakened with outside physical or
auditory stimulation. The inability to waken differentiates coma from sleep.
Patients can have different levels of unconsciousness and unresponsiveness
depending upon how much or how little of the brain is functioning.
What is the Glasgow Coma Scale?
The Glasgow Coma Scale was developed to provide health-caregivers a
simple way of measuring the depth of coma based upon observations of eye
opening, speech, and movement. Patients in the deepest level of coma:
respond with any body movement to pain,
do not have any speech, and
do not open
Those in lighter comas may offer some response, to the point they may
even seem wake, yet meet the criteria of coma because they do not respond to
The scale is used as part of the initial evaluation of a patient, but does not
assist in making the diagnosis as to the cause of coma. Since it "scores" the
level of coma, the Glasgow Coma Scale can be used as a standard method for any health-caregiver to assess change in patient status.
The best use of the Glasgow Coma Scale is to allow caregivers of different clinical skills and training to consistently assess a patient over longer periods of time in order to determine whether the patient is improving, deteriorating, or
remaining the same. In the initial care of a comatose patient, there may be first responders, EMTs, paramedics, emergency physicians, neurologists, neurosurgeons, and nurses evaluating the patient. The
Glasgow Coma Scale allows a standard assessment that can be shared.
Glasgow Coma Scale
To loud voice
Withdraws from pain
Abnormal flexion posturing
A fully awake patient has a Glasgow Coma Score of 15. A person who has
deceased has a Glasgow Coma Scale of 3 (there is no lower score).
Reviewed by William C. Shiel Jr., MD, FACP, FACR on 10/5/2011
Sports and Concussions: What Are the Recommendations?
When it comes to making recommendations, doctors' organizations tend to come
late to the game, calling press conferences to state the obvious. A recent came from the American Academy of Neurology with their pronouncement
that "any athlete who is suspected to have suffered a concussion should be
removed from participation until he or she is evaluated by a physician with
training in the evaluation and management of sports concussions." The Academy's
position also included an educational component to increase concussion education
for parents, athletes, and coaches; and reminded us that players should not
return to competition until they had recovered from their injury.
It took a little while for common sense to return to the halls of neurology
academia; their last position paper from 1997 allowed players with concussions
to return to play immediately if they were deemed to be asymptomatic with normal
neurologic assessment at rest and with exercise. It was routine to see players
running on the sideline after a head injury, as part of their evaluation to
determine if concussion symptoms could be provoked.