Glasgow Coma Scale: Breakdown & Scoring

GCS

Objective clinical tool used to assess consciousness and coma depth following head injury or medical trauma.

The GCS scores three behavioral responses: Eye opening (1-4), Verbal response (1-5), and Motor response (1-6). Total scores range from 3 (deep coma or death) to 15 (fully awake, oriented).

Systematic Breakdown

Eyes (1-4

4: Spontaneous, 3: To voice, 2: To pain, 1: None

4=Eyes open spontaneously; 3=Opens to speech; 2=Opens to painful stimuli; 1=Does not open eyes to any stimulus.

Verbal (1-5

5: Oriented, 4: Confused, 3: Words, 2: Sounds, 1: None

5=Oriented to person/place/time; 4=Confused conversation; 3=Inappropriate words; 2=Incomprehensible sounds/groaning; 1=No verbal response.

Motor (1-6

6: Obeys, 5: Localizes, 4: Withdraws, 3: Flexion, 2: Extension, 1: None

6=Obeys commands; 5=Localizes painful stimulus; 4=Normal flexion withdrawal; 3=Abnormal decorticate flexion; 2=Decerebrate extension; 1=Flaccid, no motor response.

High-Yield Clinical Pearls & Exam Tips

Golden Rule: 'GCS of 8, Intubate!' A score <= 8 indicates an inability to protect the airway and severe traumatic brain injury.
Decerebrate posturing (score 2 - extensor response) indicates midbrain or upper pontine damage and carries worse prognosis than decorticate posturing (score 3 - flexor response, cerebral hemisphere damage).

Related Pharmaceuticals

Mannitol Hypertonic Saline (3%) Propofol

Related Clinical Conditions

Traumatic Brain Injury Subarachnoid Hemorrhage Coma

Authoritative Sources: Teasdale G, Jennett B. Assessment of coma and impaired consciousness. Lancet. 1974 · ATLS 10e

Glasgow Coma Scale: Breakdown & Scoring

Systematic Breakdown

4: Spontaneous, 3: To voice, 2: To pain, 1: None

5: Oriented, 4: Confused, 3: Words, 2: Sounds, 1: None

6: Obeys, 5: Localizes, 4: Withdraws, 3: Flexion, 2: Extension, 1: None

More Emergency Medicine Mnemonics

Pain Assessment Framework: OPQRST

Burns Fluid Resuscitation: Parkland Formula & Rule of 9s

Reversible Causes of Cardiac Arrest: 5 H's & 5 T's

System Notice

Confirm Action