Glasgow Coma Scale (GCS) Made Easy: A Step-by-Step Guide, Glasgow Coma Scale (GCS) Chart for Quick Reference, Glasgow Coma Scale Components: Eye, Verbal, and Motor Responses Explained

Glasgow Coma Scale (GCS) 

The Glasgow Coma Scale (GCS) is a standardized neurological tool used to assess a patient’s level of consciousness (LOC) after head injury, trauma, or in critical care settings.

💡 Why is GCS important?

• Helps determine severity of brain injury

• Guides treatment decisions (e.g., intubation if GCS ≤ 8)

• Monitors patient progress over time

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🧠 Components of GCS

GCS is based on three responses:

1. Eye Opening (E) → 1 to 4 points

2. Verbal Response (V) → 1 to 5 points

3. Motor Response (M) → 1 to 6 points

👉 Total Score = E + V + M (Minimum: 3, Maximum: 15)

• GCS 3 = Deep coma or death

• GCS 15 = Fully awake and alert

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🔹 1. Eye Opening (E)

Measures how well the patient responds to stimuli by opening their eyes.

Score	Response	Example
4	Spontaneous	Eyes open without any stimulation
3	To voice	Opens eyes when spoken to
2	To pain	Opens eyes only with painful stimulus (e.g., pressure on fingernail)
1	No response	No eye-opening even with painful stimulus

🔹 Clinical Tip: If the patient’s eyes are swollen shut due to trauma, record as “C” (Closed) instead of 1.

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🔹 2. Verbal Response (V)

Evaluates speech and orientation.

Score	Response	Example
5	Oriented	Knows name, place, time (e.g., "My name is John, I'm in a hospital.")
4	Confused	Can talk but gives wrong answers (e.g., "I’m at home" instead of "hospital")
3	Inappropriate words	Random words or phrases (e.g., "apple car" instead of a sentence)
2	Incomprehensible sounds	Groaning, mumbling, or moaning
1	No response	No verbal response

🔹 Clinical Tip:

• If the patient is intubated or has a tracheostomy, record as “T” (Tracheostomized) instead of scoring.

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🔹 3. Motor Response (M)

Assesses movement and reaction to pain.

Score	Response	Example
6	Obeys commands	Moves limbs on request (e.g., "Raise your hand" → patient lifts hand)
5	Localizes pain	Reaches towards the pain source (e.g., pressure on fingernail → patient moves hand toward it)
4	Withdraws from pain	Pulls away from pain but doesn’t locate it
3	Abnormal flexion (Decorticate)	Arms flexed, fists clenched, legs stiff (sign of severe brain damage)
2	Abnormal extension (Decerebrate)	Arms extended, wrists rotated outward, legs stiff (worse than decorticate)
1	No response	No movement at all

🔹 Pain Stimulus Options:

• Trapezius squeeze (pinching the muscle near the shoulder)

• Supraorbital pressure (pressing the ridge above the eye)

• Sternal rub (firm pressure on the sternum)

• Nail bed pressure (pressing a fingernail or toenail)

🚨 Decorticate (Flexion) vs. Decerebrate (Extension):

• Decorticate (Flexion, Score: 3): Arms bent, fists clenched, legs extended → Damage to brain cortex

• Decerebrate (Extension, Score: 2): Arms straight, wrists twisted outward, legs stiff → Brainstem damage (worse prognosis)

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📝 How to Calculate the GCS Score?

🔹 GCS = Eye (E) + Verbal (V) + Motor (M)

Total GCS Score	Severity
13-15	Mild brain injury
9-12	Moderate brain injury
3-8	Severe brain injury (coma)

🚨 Rule of Thumb:
🧠 "GCS ≤ 8 → Intubate!" (Think: "Less than 8, intubate!")

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📊 GCS Examples - Case Studies

🩺 Case 1: Head Injury Patient

• Eyes open to pain (E2)

• Says random words (V3)

• Withdraws from pain (M4)

• GCS = 2 + 3 + 4 = 9 (Moderate brain injury)

🩺 Case 2: Comatose Patient

• No eye opening (E1)

• No verbal response (V1)

• No motor movement (M1)

• GCS = 1 + 1 + 1 = 3 (Severe coma, poor prognosis)

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🧑‍⚕️ Interactive Self-Check (Test Your Knowledge!)

✅ Scenario 1: A patient is drowsy, opens eyes only to voice, speaks but is confused, and follows commands.
What is their GCS score? 🤔

✅ Scenario 2: A trauma patient has no eye opening, moans incomprehensibly, and withdraws from pain.
What is their GCS score? 🤔

💬 Write your answers below! ⬇️

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🩺 Additional Notes for Nurses & Paramedics

✔ GCS should be reassessed regularly (e.g., every 15 min in trauma)
✔ Always document any changes in GCS over time
✔ Consider sedation effects (e.g., patients on pain meds may have lower GCS)
✔ For intubated patients, record "T" instead of Verbal Score