Glasgow Coma Scale (GCS): How to Calculate a Score; Charts and Mnemonics
Glasgow Coma Scale (GCS): How to calculate a GCS score. Charts, mnemonic, and quiz included! Assessment for EMTs, nursing, and more!
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Glasgow Coma Scale (GCS)
Eye Opening (E)
4: Eyes open spontaneously
3: Eyes open to sound
2: Eyes open to pain
1: No eye opening
Verbal Response (V)
5: Oriented
4: Confused conversation
3: Inappropriate/random words
2: Incomprehensible sounds
1: No verbal response
Motor Response (M)
6: Obeys/follows commands
5: Localize to pain
4: Withdrawal to pain (normal flexion)
3: Abnormal flexion to pain (decorticate)
2: Abnormal extension to pain (decerebrate)
1: No motor response
Note: A modified version of the GCS, called the GCS-P, also incorporates pupillary light reflex to the above. This lecture will focus on the standard GCS.
Glasgow Coma Scale (GCS): Chart and GCS scores for eye opening, verbal response, and motor response.
Glasgow Coma Scale - Made Easy
This lecture includes:
How to calculate a GCS score
Memory tricks
Mnemonics
Charts
Simple explanations
And more!
Practice Questions
Important: Don’t miss the practice questions at the end!
Great for EMTs, nursing, and more!
Comment: Leave a comment at the end on how many questions you got right!
Glasgow Coma Scale (GCS): This lecture includes charts, scores, mnemonics, and quizzes. Master how to calculate a GCS score!
What is the Glasgow Coma Scale?
The Glasgow Coma Scale (GCS) is a clinical scale that assesses a patient’s level of consciousness.
What is consciousness?
Consciousness involves how awake, alert, and aware (oriented) a person is.
Remember the A’s!
Awake
Alert
Aware (oriented)
Simply put, the GCS is a tool to measure how awake, alert, and aware a patient is.
Collectively, this helps determine how responsive and oriented they are.
Glasgow Coma Scale (GCS) - Meaning: A clinical scale used to measure a patient’s level of consciousness (how awake, alert, and aware a patient is).
When is the GCS Used?
The Glasgow Coma Scale (GCS) is typically used:
When there may be impaired consciousness
Or when consciousness needs to be assessed, monitored, etc.
Examples of when the GCS is used include:
Trauma patients
Concern for brain injury
Critically ill patients
Acute medical situations where consciousness is impaired
Seizures
Strokes
Hypoglycemia (low blood sugar)
Etc.
Glasgow Coma Scale (GCS) - Assessment: The GCS can be used for trauma patients, brain injury, critically ill patients, or acute medical situations (seizures, strokes, etc.)
How to Calculate a GCS
To calculate a Glasgow Coma Scale (GCS) score:
Step 1 - Measure 3 parameters:
Patient’s best eye opening response (E)
Patient’s best verbal response (V)
Patient’s best motor response (M)
Step 2 - Assign a score for each parameter:
Eye opening: 1-4
Verbal response: 1-5
Motor response: 1-6
Step 3 - Add the scores from each parameter to get the total GCS score:
Total GCS score = 3-15
GCS = 3 (worst)
GCS = 15 (best)
Let’s look at these steps in more detail.
Step 1 - Measure 3 Parameters
To calculate a Glasgow Coma Scale (GCS) score, there are 3 parameters to measure:
Eye opening response (E)
Verbal response (V)
Motor response (M)
The abbreviation EVM can be used to remember - Eyes, Verbal, and Motor.
The patient’s best response for each parameter is measured.
A score is then assigned for each parameter based on the patient’s best response.
How to Calculate a GCS Score: The Glasgow Coma Scale measures a patient’s eye opening response (E), verbal response (V), and motor response (M).
Step 2 - Assign a Score for Each Parameter
Each parameter has a score range:
Eye opening: 1-4
Verbal response: 1-5
Motor response: 1-6
The minimum (worst) score for each parameter is a 1.
The maximum (best) score for each parameter is a 4 (eyes), 5 (verbal), or 6 (motor).
Glasgow Coma Scale (GCS) Score: The GCS score range for each parameter is 1-4 for eye opening (E), 1-5 for verbal response (V), and 1-6 for motor response (M).
Memory Trick
Here is a simple memory trick to remember the max scores for each parameter.
The word “eyes” has 4 letters in it, and the max score is 4.
Then simply move down the body adding 1 point for each.
Start at the eyes:
Eyes = 4
Then move down to the mouth and add 1 point:
Mouth (verbal) = 5
Then move down to the body and add 1 point:
Body (motor) = 6
Recap: We have learned the parameters are EVM, and the max scores are 4, 5, 6, respectively.
GCS Score: Use EVM 456 to remember the max score for eyes (E) is 4, verbal (V) is 5, and motor (M) is 6. Eyes has 4 letters (max score 4), then move down the body adding 1 point.
Step 3 - Add the Scores (Total GCS)
The scores for each parameter are then added up to calculate the total GCS score:
Total GCS Score = 3-15
Min GCS Score = 3
Max GCS Score = 15
The lower the GCS score, the worse the patient is.
The higher the GCS score, the better the patient is.
The lowest possible GCS score is 3.
This is 1 point for the eyes (E), 1 point for verbal (V), and 1 point for motor (M).
This can be written E(1) V(1) M(1) = 3
Important: You cannot have a GCS score of 0!
This is because the minimum score for each parameter is a 1, not a 0.
A minimum GCS score of 3 indicates:
Patient is unresponsive
Severe brain injury
Deep coma
The highest possible GCS score is 15.
This is 4 points for the eyes (E), 5 points for verbal (V), and 6 points for motor (M).
This can be written E(4) V(5) M(6) = 15.
A maximum GCS score of 15 indicates:
Patient is fully awake
Full conscious
Responsive
Glasgow Coma Scale (GCS) Chart: A total GCS score ranges from 3-15. A maximum GCS score of 15 means the patient is fully awake (responsive). A minimum GCS score of 3 means the patient is in a deep coma (unresponsive).
Eye Opening - GCS Score
Glasgow Coma Scale (GCS) - Eye Opening (E)
4 = Eyes open spontaneously
3 = Eyes open to sound
2 = Eyes open to pain
1 = No eye opening
Memory Trick: No Pain Sounds Good
4 = Eyes open spontaneously
A score of 4 is the best, and it means the patient is opening their eyes spontaneously.
The patient does not require a stimulus, such as sound or pain, to open their eyes.
3 = Eyes open to sound
A score of 3 means the patient opens their eyes in response to sound.
The sound stimulus could be a verbal command or a loud noise.
Example: The patient’s eyes are closed, but open when you ask them to open them.
2 = Eyes open to pain
A score of 2 means the patient opens their eyes in response to pain.
A peripheral pain stimulus is typically preferred (i.e. pressure to nail bed, etc.).
This avoids a reflex response or grimacing effect.
Example: The patient’s eyes are closed and don’t open to sound, but they do open when you apply pressure to their nail bed.
1 = No eye opening
A score of 1 is the worst.
It means the patient’s eyes do not open - not even with sound or a painful stimulus.
Glasgow Coma Scale (GCS) Chart - Eyes: The GCS score range for eye opening is 1 (worst) to 4 (best).
Memory Trick - Mnemonic
You can use the mnemonic “No Pain Sounds Good” to remember the eye opening scores.
“No Pain Sounds Good”
No = 1 = NO eye opening
Pain = 2 = Eyes open to PAIN
Sounds = 3 = Eyes open to SOUND
Good = 4 = Everything is “GOOD”, eyes open spontaneously
Each word in the mnemonic represents an eye score.
No represents a score of 1, which is no response.
Pain represents a score of 2, which is response to pain.
Sounds represents a score of 3, which is response to sound.
Good represents a score of 4, which means “everything’s good” - the eyes open spontaneously.
Summary: No (1) Pain (2) Sounds (3) Good (4)
Glasgow Coma Scale (GCS) Mnemonic - Eyes: Use the mnemonic “No Pain Sounds Good” to remember the GCS scores for eye opening
Verbal Response - GCS Score
Glasgow Coma Scale (GCS) - Verbal Response (V)
5 = Oriented
4 = Confused conversation
3 = Inappropriate/random words
2 = Incomprehensible sounds
1 = No verbal response
Memory Trick: Don’t Moan Random Confused Words
5 = Oriented
A score of 5 is the best, and it means the patient is oriented.
In other words, the patient is communicating normally, answering questions appropriately, and they know their name, location, date, etc.
4 = Confused conversation
A score of 4 is slightly worse, and it means the patient is confused.
The patient can communicate and form words, but their conversation is confused.
In other words, their responses to questions are in the context of the question, however, they display confusion in their answers.
Example: You ask the patient the date, and they answer with the wrong year.
3 = Inappropriate/random words
A score of 3 means the patient is speaking random or inappropriate words.
The patient is still able to form words, however, the words don’t make sense in the context of the conversation.
In other words, their responses to questions are out of context.
Example: You ask the patient the date, and they answer with random words unrelated to the question.
2 = Incomprehensible sounds
A score of 2 means the patient is making incomprehensible sounds.
In this case, the patient is unable to form words.
Instead, they make incomprehensible sounds, such as moaning or groaning.
Example: You ask the patient the date, and they moan and groan without words.
1 = No verbal response
A score of 1 is the worst.
It means the patient has no verbal response - not even moaning or groaning.
Glasgow Coma Scale (GCS) Chart - Verbal: The GCS score range for verbal response is 1 (worst) to 5 (best).
Memory Trick - Mnemonic
You can use the mnemonic “Don’t Moan Random Confused Words” to remember the verbal response scores.
“Don’t Moan Random Confused Words”
Don’t = 1 = DON’T have a verbal response (no verbal response)
Moan = 2 = MOAN or incomprehensible sounds
Random = 3 = RANDOM or inappropriate words
Confused = 4 = CONFUSED conversation
Words = 5 = Normal “WORDS”, oriented and normal conversation
Each word in the mnemonic represents a verbal score.
Don’t represents a score of 1, which is no verbal response (don’t have a response).
Moan represents a score of 2, which is moaning or incomprehensible sounds.
Random represents a score of 3, which is random or inappropriate words.
Confused represents a score of 4, which is confused conversation.
Words represents a score of 5, which means “normal words” - the patient is oriented and conversing appropriately.
Summary: Don’t (1) Moan (2) Random (3) Confused (4) Words (5)
Glasgow Coma Scale (GCS) Mnemonic - Verbal: Use the mnemonic “Don’t Moan Random Confused Words” to remember the GCS scores for verbal response
Motor Response - GCS Score
Glasgow Coma Scale (GCS) - Motor Response (M)
6 = Obeys/follows commands
5 = Localize to pain
4 = Withdrawal to pain (normal flexion)
3 = Abnormal flexion to pain (decorticate)
2 = Abnormal extension to pain (decerebrate)
1 = No motor response
Memory Trick: Don’t Extend or Flex Without Local Commands
6 = Obeys/follows commands
A score of 6 is the best, and it means the patient obeys and follows commands.
This indicates the patient has normal voluntary movements in response to a command.
Two-step commands can be used.
Example: You ask the patient to stick out their tongue, wiggle their toes, raise their right arm, etc. and they proceed to follow the command.
5 = Localize to pain
A score of 5 means the patient is able to localize to pain.
In other words, the patient purposely moves their hand across their midline or above their clavicle toward a painful stimulus.
A central pain stimulus is typically preferred (i.e. trapezius squeeze, supraorbital notch pressure, etc.).
This provides a more complete assessment of brain function.
Example: You apply pressure to the patient’s supraorbital notch, and the patient moves their hand above their clavicle toward the painful stimulus.
4 = Withdrawal to pain (normal flexion)
A score of 4 means the patient has a normal flexion or withdrawal response to pain.
In other words, the patient flexes/pulls part of their body away from the pain, but they don’t localize it.
Example: You apply pressure to the patient’s supraorbital notch, and the patient flexes their arm in response but their hand does not move above their clavicle toward the stimulus.
3 = Abnormal flexion to pain (decorticate)
A score of 3 means the patient has an abnormal flexion to pain.
In other words, there is decorticate posturing in response to the pain.
Example: Decorticate Posturing
Flexion of the elbows and wrists
Adduction and internal rotation at the shoulders
Extension of the knees
Internal rotation at the hips
Plantar flexion of the feet
2 = Abnormal extension to pain (decerebrate)
A score of 2 means the patient has an abnormal extension to pain.
In other words, there is decerebrate posturing in response to pain.
Example: Decerebrate Posturing
Extension of the elbows
Pronation of the forearms
Extension of the knees
Internal rotation at the hips
Plantar flexion of the feet
Bonus Tip: A key difference between a score of 3 and a score of 2 is the elbows! The elbows flex in a 3, and they extend in a 2.
1 = No motor response
A score of 1 is the worst.
It means the patient has no motor response - not even to painful stimuli.
Glasgow Coma Scale (GCS) Chart - Motor: The GCS score range for motor response is 1 (worst) to 6 (best).
Memory Trick - Mnemonic
You can use the mnemonic “Don’t Extend or Flex Without Local Commands” to remember the motor response scores.
“Don’t Extend or Flex Without Local Commands”
Don’t = 1 = DON’T have a motor response (no motor response)
Extend = 2 = Abnormal EXTENSION to pain
Flex = 3 = Abnormal FLEXION to pain
Without = 4 = WITHDRAWAL to pain
Local = 5 = LOCALIZE to pain
Commands = 6 = Following COMMANDS
Each word in the mnemonic represents a motor score.
Don’t represents a score of 1, which is no motor response (don’t have a response).
Extend represents a score of 2, which is abnormal extension to pain.
Flex represents a score of 3, which is abnormal flexion to pain.
Without represents a score of 4, which is withdrawal to pain - use the prefix with to remember it.
Local represents a score of 5, which is localize to pain.
Commands represents a score of 6, which is following commands.
Summary: Don’t (1) Extend (2) or Flex (3) Without (4) Local (5) Commands (6)
Glasgow Coma Scale (GCS) Mnemonic - Motor: Use the mnemonic “Don’t Extend or Flex Without Local Commands” to remember the GCS scores for motor response
GCS Score Interpretation
The Glasgow Coma Scale (GCS) scores can be interpreted as follows:
GCS 13-15: Mild brain injury
GCS 9-12: Moderate brain injury
GCS 3-8: Severe brain injury
The GCS chart below correlates the GCS score with the severity of brain injury.
A GCS of 13-15 indicates a mild brain injury.
A GCS of 9-12 indicates a moderate brain injury.
A GCS of 3-8 indicates a severe brain injury.
You may hear the common saying “GCS less than 8, intubate”.
This means to consider intubating a patient with a GCS < 8.
Important: This is not a rule. Every case is different. Various scores may require intubation. Use clinical judgement and follow protocols.
Glasgow Coma Scale (GCS) Score Interpretation: The chart correlates GCS score ranges with the severity of brain injury.
Practice Questions
1. Which of the following is NOT a parameter used in calculating a GCS score?
A. Verbal response
B. Respiratory pattern
C. Motor response
D. Eye opening
2. A GCS score of 3-8 indicates what type of brain injury?
A. Mild
B. Moderate
C. Severe
3. What is the maximum possible GCS score?
A. 13
B. 14
C. 15
D. 16
4. What is the minimum possible GCS score?
A. 0
B. 1
C. 2
D. 3
5. When can the GCS score be used?
A. Trauma patients
B. Critically ill patients
C. Concern for brain injury
D. Hypoglycemic patients
E. All of the above
6. You ask a trauma patient “Do you know what day it is?” The patient responds, “The shoe is eating.” What is the patient’s GCS verbal score?
A. V(1)
B. V(2)
C. V(3)
D. V(4)
E. V(5)
7. You ask a trauma patient to lift their right leg, and there is no response. You apply pressure to the patient’s supraorbital notch. The patient’s elbows flex, arms adduct, shoulders and hips internally rotate, knees extend, and there is plantar flexion. What is the patient’s GCS motor score?
A. M(1)
B. M(2)
C. M(3)
D. M(4)
E. M(5)
F. M(6)
8. A patient arrives to the hospital after a motor vehicle accident. Their eyes are closed and do not open when you ask them to open them. When you apply pressure to the patient’s nail bed, their eyes open. You ask the patient what happened, and the patient groans. You ask the patient to stick out their tongue, and there is no response. You apply pressure to the patient’s right trapezius, and their right arm pulls away without moving their hand toward the trapezius. What is the patient’s total GCS score?
Bonus: What are the individual scores for each parameter?
A. 7
B. 8
C. 9
D. 10
E. 11
Comment Below: How many questions did you get right? Leave a comment below!
Answers
1. B
2. C
3. C
4. D
5. E
6. C
7. C
8. B - E(2) V(2) M(4) = 8
Leave a Comment Below - Let us know how many questions you got right!
Last updated 09/15/2025
References
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Scriven J. Glasgow Coma Scale (GCS) and Neurological Observations - OSCE Guide. Geeky Medics. Accessed 2025 Sep 15. https://geekymedics.com/glasgow-coma-scale-gcs
Tindall SC. Level of Consciousness. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 57. Accessed 2025 Sep 15. https://www.ncbi.nlm.nih.gov/books/NBK380/
UpToDate, Inc. Glasgow Coma Scale (GCS). UpToDate. Copyright 2025. Accessed 2025 Sep 15. https://www.uptodate.com/contents/image?imageKey=NEURO/81854