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GCS Made Simple


Assessing GCS of a patient within a minute is an important skill every Medizen must have. Though most Emergency Rooms have charts sticked to the walls,Its always better to imprint these in ur mind so as to not get embarassed in front of consultants or ur juniors. Lets dig into it..!

Why GCS?

When someone faints on the road,the first thing people check for is consciousness, i.e "the state of being aware and being responsive". But in a hospital setup just assessing for consciousness is not sufficient.We have to assess the 'level of consciousness'. For this purpose, Many scales were devised, the most widely accepted and used is the Glasgow Coma Scale devised by two renowned neurosurgeons who worked at the Glasgow University and hence the name.

What is GCS?

As discussed above, It is a neurological scale used to assess the level of consciousness in a case of head injury or a comatose patient in an ICU. It can be used subsequently and compared to the earlier score to understand the prognosis of the illness.
The maximum score possible is 15 and the minimum is 3. So Remember, even a dead patient will have a GCS score of 3 and not 0.
It is divided into 3 components namely,
  1. Eye Opening
  2. Verbal Response
  3. Motor Response
The Mantra of GCS you must remember is
"E4V5M6"
This number here, denotes the number of points in each component.

Eye opening:(E4)

  • His eyes are open and blinking-4
  • He opens his eyes on calling him loud-3
  • He opens his eyes,on giving a pain stimuli-2
  • No response whatsoever-1

Verbal Response:(V5)

  • He converses normally-5
  • He is confused,answers inappropriately-4
  • His words are incomprehensible-3
  • Makes only sounds,no words-2
  • No response whatsoever-1

Motor Response:(M6)

  • Obeys motor commands-6
  • Localises painful stimuli-5
  • Withdraws from painful stimuli-4
  • Flexion of limbs to pain(decorticate)-3
  • Extension of limbs to pain(decerebrate)-2
  • No response whatsoever-1
This sums up to the number 15. But What if the patient is intubated or his face is swollen, he couldnt open his eyes impeding assessment of verbal response and eye opening?
For this we use V-T if intubated and V-C if eyes are closed due to swelling, and is given a score of 1.

How to assess?

   1)  First look at him, If he appears to be awake, talk to him and assess the verbal component, then make him do a motor task.

Example 1: 
He makes eye contact- E4
"What is your name"
   'How did I come here'- V4
"Please raise ur right arm"
He does-M6
GCS is E4V4M6, with a total score of 14.

   2)  If he appears sleepy or drowsy, call him loudly by his name, if he is arousable,Assess verbal and motor component by the same method.

Example 2: 
He opens his eyes briefly to verbal stimuli- E3
"What is ur name"
   'mmmm aahh'- V2
"Please raise ur right arm"
   No response
Give a painful stimuli
   Withdraws his limb away from the direction of pain-M4
GCS is E3V2M4, with a total score of 9.

   3)  If he is not arousable by voice,give him a painful stimuli and assess eye opening,verbal and motor component simultaneously as the response wil occur simultaneously.

Example 3: 
He did not open his eyes- E1
no verbal response- V1
flexes his limb abnormally- M3 
GCS is E1V1M3 with a total score of 5.

Example 4: 
If he is intubated,opens his eyes spontaneously,obeys motor command his GCS is E4VTM6 with a total score of 11.

Remember, In the beginning You will find it a bit tough to assess the GCS correctly .But with regular practise, You will able to tell the GCS just by looking,speaking and giving a painful stimuli within a minute..Keep Medizening..!!

Dr.Praful JK, MBBS
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