The Glasgow Coma Scale (GCS) is a vital clinical tool used by healthcare professionals to assess and monitor a patient’s level of consciousness after a traumatic brain injury or other neurological impairment.
Developed in 1974 by neurosurgeons Graham Teasdale and Bryan Jennett, the GCS provides a standardized, objective method for evaluating a patient’s responsiveness in three key areas: eye opening, verbal response, and motor response. This simple yet effective scale helps guide treatment decisions, track changes in neurological status, and predict patient outcomes.
In this article, we’ll explore how the Glasgow Coma Scale works, how to interpret the scores, and why it remains an essential component of neurological assessment in emergency and critical care settings.
What is the Glasgow Coma Scale (GCS)?
The Glasgow Coma Scale (GCS) is a widely used clinical tool for objectively assessing a patient’s level of consciousness, particularly in cases of head trauma or suspected neurological impairment. It’s especially important for respiratory therapists to understand this scale, as GCS scores help guide decisions about airway protection and the need for intubation.
The GCS evaluates three components:
- Eye Opening (E) – scored from 1 to 4
- Verbal Response (V) – scored from 1 to 5
- Motor Response (M) – scored from 1 to 6
Each component is rated based on specific observed responses, and the scores are summed to give a total ranging from 3 (deep coma) to 15 (fully alert). Here’s a quick breakdown:
Eye Opening (E)
- 4 – Spontaneous
- 3 – To verbal command
- 2 – To pain
- 1 – No eye opening
Verbal Response (V)
- 5 – Oriented, converses normally
- 4 – Confused conversation
- 3 – Inappropriate words
- 2 – Incomprehensible sounds
- 1 – No verbal response
Motor Response (M)
- 6 – Obeys commands
- 5 – Localizes pain
- 4 – Withdraws from pain
- 3 – Abnormal flexion (decorticate)
- 2 – Extension to pain (decerebrate)
- 1 – No motor response
Interpretation of GCS Scores
- 13–15 = Mild brain injury
- 9–12 = Moderate brain injury
- 8 or below = Severe brain injury or coma (often requires airway intervention)
Note: In clinical simulations or real-world emergency care, if a patient has a GCS ≤ 8, it’s often recommended to intubate to protect the airway due to the risk of aspiration and inability to maintain airway patency.
Understanding the Components of the Glasgow Coma Scale
The Glasgow Coma Scale is based on three clinical observations, each assigned a numeric score:
- Eye Opening (E) – Ranges from 1 to 4, assessing w`hether the patient opens their eyes spontaneously, in response to speech, or to pain.
- Verbal Response (V) – Ranges from 1 to 5, evaluating the patient’s ability to speak, including whether their responses are oriented, confused, inappropriate, incomprehensible, or absent.
- Motor Response (M) – Ranges from 1 to 6, measuring the patient’s ability to follow commands or react to painful stimuli with purposeful or reflexive movements.
Note: By adding the scores from each category, clinicians derive a total GCS score ranging from 3 to 15. A higher score indicates a more alert and responsive patient, while a lower score suggests more severe impairment.
Interpreting GCS Scores
- Mild Injury: GCS score of 13–15
- Moderate Injury: GCS score of 9–12
- Severe Injury: GCS score of 8 or below
A GCS score of 8 or less is generally considered a critical threshold, often prompting airway protection measures such as intubation. Repeated assessments over time help clinicians detect any changes in a patient’s condition, guiding timely interventions.
Why the GCS Is So Important
The Glasgow Coma Scale is widely used in emergency departments, intensive care units, and pre-hospital settings because of its simplicity, reliability, and consistency. It plays a crucial role in initial triage decisions and ongoing neurological evaluations, especially in trauma care.
Whether used by paramedics in the field or physicians in a hospital, the GCS remains a cornerstone of neurological assessment and decision-making.
Limitations of the Glasgow Coma Scale
While the Glasgow Coma Scale is a valuable assessment tool, it does have limitations that healthcare providers must consider. For example, it may be difficult to accurately assess verbal responses in intubated patients or those with language barriers.
Similarly, patients who are sedated, under the influence of drugs or alcohol, or have pre-existing neurological conditions may present with misleading scores. Additionally, the GCS may not capture subtle changes in neurological function, especially in cases involving focal brain injuries where localized deficits might not significantly affect the overall score.
In pediatric populations, especially infants and toddlers, the standard GCS may not be appropriate due to developmental differences in communication and motor skills. In these cases, a modified version of the scale known as the Pediatric Glasgow Coma Scale is used, which adjusts scoring criteria to better reflect age-appropriate responses.
Clinical Applications and Real-World Use
Despite its limitations, the Glasgow Coma Scale remains a fundamental part of neurological assessments across a wide range of clinical settings. Emergency medical responders use the GCS in the field to quickly assess trauma victims and communicate the severity of injury to receiving hospitals.
In intensive care units, the scale helps track a patient’s neurological progression or deterioration over time. It also plays a role in determining prognosis, especially following traumatic brain injuries, strokes, or cardiac arrest.
Why the Glasgow Coma Scale Is Relevant for Respiratory Therapists
For respiratory therapists, the Glasgow Coma Scale (GCS) is more than just a neurological assessment tool—it’s a critical indicator that directly influences airway management decisions. One of the most important roles of a respiratory therapist is to ensure that a patient’s airway is protected and that they are receiving adequate ventilation.
A GCS score of 8 or below typically signals a decreased level of consciousness, which puts the patient at risk for airway obstruction, aspiration, and respiratory failure. In such cases, immediate intervention—often including endotracheal intubation and mechanical ventilation—is required.
Understanding and interpreting GCS scores allows respiratory therapists to work collaboratively with the healthcare team to determine when advanced airway support is needed. It also helps them anticipate potential complications and prepare the necessary equipment for intubation or ventilation. In emergency settings, a rapid GCS assessment can guide respiratory therapists in prioritizing care, especially when multiple trauma or critical care patients are involved.
Additionally, respiratory therapists may use changes in GCS over time to monitor the effectiveness of interventions and recognize signs of neurological improvement or deterioration.
Whether working in the emergency department, intensive care unit, or transport team, being familiar with the Glasgow Coma Scale equips respiratory therapists with the information they need to deliver safe, timely, and effective respiratory care.
Glasgow Coma Scale (GCS) Practice Questions
1. What are the three categories evaluated in the Glasgow Coma Scale (GCS)?
Best Eye Response, Best Verbal Response, and Best Motor Response
2. A score of 4 in Best Eye Response indicates:
The patient’s eyes open spontaneously
3. A score of 3 in Best Eye Response indicates:
The patient’s eyes open in response to speech
4. A score of 2 in Best Eye Response indicates:
The patient’s eyes open only in response to painful stimuli
5. A score of 1 in Best Eye Response indicates:
No eye opening or response
6. A score of 5 in Best Verbal Response indicates:
The patient is oriented to person, place, and time
7. A score of 4 in Best Verbal Response indicates:
The patient is confused but able to respond coherently
8. A score of 3 in Best Verbal Response indicates:
The patient uses inappropriate words or phrases
9. A score of 2 in Best Verbal Response indicates:
The patient makes incomprehensible sounds
10. A score of 1 in Best Verbal Response indicates:
No verbal response is present
11. A score of 6 in Best Motor Response indicates:
The patient follows commands for movement
12. A score of 5 in Best Motor Response indicates:
The patient localizes pain by moving toward it
13. A score of 4 in Best Motor Response indicates:
The patient withdraws from pain with flexion
14. A score of 3 in Best Motor Response indicates:
The patient displays abnormal flexion (decorticate posture)
15. A score of 2 in Best Motor Response indicates:
The patient shows abnormal extension (decerebrate posture)
16. A score of 1 in Best Motor Response indicates:
No motor response is observed
17. What is the scoring range of the Glasgow Coma Scale?
3 to 15
18. An overall GCS score of 3 indicates:
Deep coma or total unresponsiveness
19. An overall GCS score of 8 or less indicates:
Severe brain injury; the patient is comatose and requires airway protection
20. An overall GCS score between 9 and 14 indicates:
Moderate impairment; monitor closely for deterioration
21. A GCS score of 15 indicates:
The patient is fully alert, responsive, and maintaining their own airway
22. If a patient has a GCS score between 9 and 14, what should the respiratory therapist do?
Closely monitor the patient’s condition, as rapid deterioration may require intubation and mechanical ventilation.
23. What should be done if a patient’s GCS is less than 8?
Secure the airway with endotracheal intubation and proceed with diagnostic evaluation.
24. A 21-year-old male is extremely intoxicated. When you attempt to insert a nasal airway, he slaps your hand away, curses at you, and then sits up. After you remove the airway, he lies back down on the stretcher. What is his Glasgow Coma Scale score?
GCS 11 — Eye Opening: 1 (none), Verbal Response: 5 (oriented), Motor Response: 5 (localizes pain)
25. A 56-year-old male complains of abdominal pain, tells you he wants to go to the hospital, and walks to the stretcher with your assistance. What is his Glasgow Coma Scale score?
GCS 15 — Full score: Eyes 4, Verbal 5, Motor 6
26. A 44-year-old female fell off a roof. She produces incomprehensible sounds in response to your commands. Her eyes do not open to pain, but she moves her legs when her trapezius is pinched. What is her Glasgow Coma Scale score?
GCS 7 — Eye Opening: 1 (none), Verbal Response: 2 (incomprehensible), Motor Response: 4 (withdraws from pain)
27. A 17-year-old male overdosed on narcotics. He looks around with an unfocused gaze, mumbles in response to questions, and pulls away from painful stimuli. What is his Glasgow Coma Scale score?
GCS 10 — Eye Opening: 3 (to speech), Verbal Response: 3 (inappropriate words), Motor Response: 4 (withdraws)
28. A 28-year-old female with a closed head injury moans and exhibits abnormal flexion of the arms (decorticate posture). She points her toes during splinting of a fractured extremity. What is her Glasgow Coma Scale score?
GCS 6 — Eye Opening: 1 (none), Verbal Response: 2 (incomprehensible), Motor Response: 3 (abnormal flexion)
29. A 6-year-old male fell 6 feet from a tree. He is awake, moving all extremities, and clearly explains what happened before talking about his dog. What is his Glasgow Coma Scale score?
GCS 15 — Eye 4, Verbal 5, Motor 6
30. A 37-year-old intoxicated female with a fractured leg looks at you and withdraws her leg when a splint is applied. She grunts in pain. What is her Glasgow Coma Scale score?
GCS 8 — Eye Opening: 2 (to pain), Verbal Response: 2 (incomprehensible), Motor Response: 4 (withdraws)
31. A 24-year-old female overdosed on an unknown substance. She is staring into space and babbling. When painful stimuli are applied, she cries out incomprehensibly but does not withdraw. What is her Glasgow Coma Scale score?
GCS 9 — Eye Opening: 2 (to pain), Verbal Response: 2 (incomprehensible), Motor Response: 5 (localizes)
32. An 85-year-old male in a nursing home walks around and greets you. He speaks clearly, but his responses are confused and rambling. What is his Glasgow Coma Scale score?
GCS 14 — Eye 4, Verbal 4 (confused), Motor 6
33. A 20-year-old female fell 20 feet while rock climbing. When a sternal rub is applied, she exhibits extension in both arms and legs with no other response. What is her Glasgow Coma Scale score?
GCS 4 — Eye Opening: 1 (none), Verbal Response: 1 (none), Motor Response: 2 (extension)
34. A 64-year-old male looks at you when spoken to. When asked the date, he says “blue.” He has left-sided weakness but follows motor commands. What is his Glasgow Coma Scale score?
GCS 13 — Eye 4, Verbal 3 (inappropriate), Motor 6
35. An 81-year-old male is pulseless and unresponsive in bed with dried blood visible in the nose and ears. What is his Glasgow Coma Scale score?
GCS 3 — No eye, verbal, or motor response
36. A 30-year-old male is found unresponsive on the sidewalk outside a homeless shelter. When painful stimuli are applied, he opens his eyes, tells you to go away, and pushes your hand away. What is his Glasgow Coma Scale score?
GCS 12 — Eye 2 (to pain), Verbal 5 (oriented), Motor 5 (localizes pain)
37. A patient fell while rock climbing. When you apply a deep sternal rub, he extends both arms and legs and shows no other response. What is his Glasgow Coma Score?
GCS 4 — Eye Opening: 1 (none), Verbal Response: 1 (none), Motor Response: 2 (extension/decerebrate)
38. What is the Glasgow Coma Score for a patient who is pulseless and apneic?
GCS 3 — Eye: 1, Verbal: 1, Motor: 1 (total unresponsiveness)
39. A 73-year-old patient looks at you when you speak to her. When asked the date, she replies “blue.” You observe left-sided weakness when she grips your fingers. What is her Glasgow Coma Score?
GCS 13 — Eye Opening: 4 (spontaneous), Verbal: 3 (inappropriate words), Motor: 6 (obeys commands)
40. A trauma patient moans, bends his arms toward his chest (decorticate posture), and points his toes when you attempt to start an IV. What is his Glasgow Coma Score?
GCS 6 — Eye: 1 (none), Verbal: 2 (incomprehensible), Motor: 3 (abnormal flexion)
41. A 7-year-old boy who fell off a jungle gym is alert and moving all four extremities. When asked what happened, he explains the fall and begins talking about his dog. What is his Glasgow Coma Score?
GCS 15 — Eye: 4, Verbal: 5, Motor: 6 (fully alert and oriented)
42. You are assessing a 20-year-old male suspected of overdosing. He is staring into space, writhing, and babbling. When you start an IV, he cries out incomprehensibly but does not withdraw. What is his Glasgow Coma Score?
GCS 9 — Eye: 2 (to pain), Verbal: 2 (incomprehensible), Motor: 5 (localizes pain)
43. You are transporting an intoxicated patient. When you attempt to insert a nasal airway, he slaps your hand away, curses at you, and sits up. Once you stop, he lies back down on the stretcher. What is his Glasgow Coma Score?
GCS 11 — Eye: 1 (none), Verbal: 5 (oriented), Motor: 5 (localizes pain)
44. A 75-year-old male is rubbing his chest and tells you it hurts. He asks to go to the hospital and walks to the stretcher with your help. What is his Glasgow Coma Score?
GCS 15 — Eye: 4, Verbal: 5, Motor: 6 (fully responsive and oriented)
45. A man is found outside a homeless shelter. When you apply a sternal rub, he opens his eyes, tells you to go away, and pushes your hand away. What is his Glasgow Coma Score?
GCS 12 — Eye: 2 (to pain), Verbal: 5 (oriented), Motor: 5 (localizes pain)
46. A possible overdose patient is looking around with an unfocused gaze. He mumbles when spoken to and pulls away from painful stimulus. What is his Glasgow Coma Score?
GCS 10 — Eye: 3 (to speech), Verbal: 3 (inappropriate words), Motor: 4 (withdraws from pain)
47. An elderly female in a nursing home is walking around and greets you when you enter. She speaks clearly, but her responses are confusing and disorganized. What is her Glasgow Coma Score?
GCS 14 — Eye: 4 (spontaneous), Verbal: 4 (confused), Motor: 6 (obeys commands)
48. An intoxicated patient appears unresponsive at first. When you start an IV, she wakes up, yells at you, then lays back down and closes her eyes. What is her Glasgow Coma Score?
GCS 12 — Eye: 2 (to pain), Verbal: 5 (oriented), Motor: 5 (localizes pain)
49. What is the best description of decorticate posturing?
The patient withdraws into their core. Decorticate posturing is characterized by abnormal flexion of the arms toward the chest, indicating damage above the brainstem. This differs from decerebrate posturing, where the arms extend outward away from the body.
50. What is the Glasgow Coma Scale (GCS) used to assess?
Level of consciousness. The Glasgow Coma Scale is a standardized tool used to evaluate a patient’s level of consciousness following a brain injury. It assesses eye, verbal, and motor responses.
51. How many points does a patient receive for spontaneous eye opening on the Glasgow Coma Scale (GCS)?
Eye response scores range from 1 to 4. A score of 4 indicates that the patient opens their eyes spontaneously, without any external stimuli.
52. What is the highest total score a patient can receive on the Glasgow Coma Scale (GCS)?
The GCS has a maximum of 4 points for eye response, 5 points for verbal response, and 6 points for motor response, totaling a maximum score of 15.
53. A patient scores 4 points for verbal response on the GCS. What does this indicate?
The patient is confused. A verbal score of 4 suggests that the patient is able to speak but appears confused or disoriented. Full orientation would score 5, while inappropriate or incomprehensible responses score 3 or 2 respectively.
54. A GCS score of 8 or less indicates what level of injury?
Severe head injury. A GCS of 8 or below is classified as a severe head injury and typically requires immediate intervention, including airway protection.
55. A GCS score between 9 and 12 indicates what level of injury?
Moderate head injury. Moderate head injuries fall within this range and often require close observation, but the need for intubation or surgical intervention depends on the clinical context.
56. A GCS score between 13 and 15 indicates what level of injury?
Mild head injury. Scores in this range are considered mild and often involve brief changes in mental status, but the patient is typically alert and oriented.
57. You have been assigned a client in the ICU. When you address him, he opens his eyes and attempts to talk, but his speech is incomprehensible. He only moves in response to pain. How would you classify this injury?
Moderate head injury. Eye opening to voice = 3, incomprehensible speech = 2, withdrawal to pain = 4. Total GCS = 9, which indicates a moderate head injury.
58. A patient in a skilled nursing facility shows no eye opening, no verbal response, and no motor response. What is her GCS score?
A total lack of response in all three categories results in the lowest possible GCS score, which is 3.
59. If your client demonstrates purposeful movement in response to painful stimuli, how many motor points does he receive on the GCS?
Localizing or purposeful response to pain is scored as 5 in the motor section of the Glasgow Coma Scale.
60. What are the three categories of response assessed in the Glasgow Coma Scale?
Eye opening, verbal response, motor response. The GCS evaluates a patient’s level of consciousness based on these three neurological functions.
61. You enter a patient’s room. She opens her eyes to your voice, answers your questions but seems confused, and follows commands to move. What is her GCS score and injury classification?
13 points / Mild head injury. Eye opening to voice = 3, confused speech = 4, obeys commands = 6. Total GCS = 13, classified as mild head injury.
62. While evaluating your ICU patient, he only opens his eyes in response to pain, his speech is incomprehensible, and he displays decerebrate posturing. What is his GCS score and injury classification?
6 points / Severe head injury. Eye opening to pain = 2, incomprehensible speech = 2, abnormal extension (decerebrate) = 2. Total GCS = 6, classified as a severe head injury.
63. A patient opens her eyes spontaneously, is verbally oriented, and shows purposeful movement only when given painful stimuli. What is her GCS score and injury classification?
14 points / Mild head injury. Spontaneous eye opening = 4, oriented verbal response = 5, localizes pain = 5. Total GCS = 14, indicating a mild head injury.
64. When you apply a sternal rub, the patient extends her arms and legs but shows no other response. What is her Glasgow Coma Scale (GCS) score?
4
65. A 56-year-old male is found unconscious in bed. He does not respond to verbal or painful stimuli and shows decorticate posturing. What is his GCS?
5
66. A 30-year-old male was found on the sidewalk outside a homeless shelter. When you apply painful stimuli, he opens his eyes, tells you to go away, and pushes your hand away. What is his GCS?
12
67. A 37-year-old intoxicated female has a fractured leg. When you apply a splint, she looks at you, withdraws her leg, and grunts in pain. What is her GCS?
8
68. An 81-year-old male is pulseless and apneic, lying supine in bed. What is his GCS?
3
69. An 85-year-old male in a nursing home greets you when you enter. He speaks clearly, but his answers are confusing and rambling. What is his GCS?
14
70. A 6-year-old boy fell 6 feet from a tree. He is awake, moving all extremities, and tells you he fell before talking about his dog. What is his GCS?
15
71. A 28-year-old female with a closed head injury moans and flexes her arms toward her chest while pointing her toes during splinting. What is her GCS?
6
72. A 64-year-old male looks at you when you speak. When asked the date, he says, “Tinkerbell.” He shows left-sided weakness when gripping your hands. What is his GCS?
13
73. A 21-year-old intoxicated male slaps your hand away when inserting a nasal airway, curses at you, and sits up. When you stop, he lies back down. What is his GCS?
11
74. A 44-year-old female fell off a roof. She moans in response to commands, her eyes remain closed, but she moves her legs to painful stimuli. What is her GCS?
7
75. A 17-year-old male overdosed on narcotics. He gazes unfocused, mumbles when questioned, and pulls away from pain. What is his GCS?
10
76. A 24-year-old female overdosed on an unknown substance. She is staring off into space and babbling. Painful stimuli make her cry out incomprehensibly but she doesn’t pull away. What is her GCS?
9
77. A 23-year-old female is alert, speaking normally, and follows commands. What is her GCS?
15
78. A 31-year-old male has closed eyes, groans when pinched, and attempts to push your hand away. What is his GCS?
8
79. A young male’s eyes are open and darting around. He doesn’t answer questions but groans and grabs your hand when touched. What is his GCS?
11
80. Your patient does not open her eyes, makes no sounds, and withdraws from pain. What is her GCS?
6
81. Your patient opens his eyes only to pain, moans, and withdraws. What is his GCS?
8
82. Your patient opens his eyes only to pain, makes no sounds, and shows decerebrate posturing. What is his GCS?
5
83. Your patient opens his eyes to pain, curses, and shows decerebrate posturing. What is his GCS?
7
84. Your patient opens eyes spontaneously, is disoriented, but follows commands. What is his GCS?
14
85. Your patient opens eyes spontaneously, is fully oriented, and follows commands. What is his GCS?
15
86. A 33-year-old female is found confused after a motor vehicle crash. She opens her eyes to voice, mumbles incoherently, and pulls away from pain. What is her GCS?
9
87. A 70-year-old male is unresponsive. He does not open his eyes, makes no sounds, and does not move to pain. What is his GCS?
3
88. A 45-year-old intoxicated female opens her eyes to pain, groans, and flexes her arms toward her chest. What is her GCS?
7
89. A 19-year-old male is awake and alert but becomes confused while answering questions. He follows all commands and opens eyes spontaneously. What is his GCS?
14
90. A 62-year-old stroke patient opens eyes to voice, speaks inappropriate words, and withdraws from pain. What is her GCS?
10
91. A 50-year-old male with a head injury opens eyes to pain, makes incomprehensible sounds, and does not respond to pain. What is his GCS?
5
92. A 27-year-old female opens her eyes spontaneously, is confused when speaking, and localizes to painful stimuli. What is her GCS?
13
93. A 40-year-old male opens his eyes to pain, speaks with inappropriate words, and shows decerebrate posturing. What is his GCS?
6
94. A 5-year-old male opens eyes to voice, cries when asked questions, and pulls his arm away from IV insertion. What is his GCS?
11
95. A 59-year-old diabetic male opens eyes spontaneously, gives oriented responses, and moves all extremities on command. What is his GCS?
15
96. A 30-year-old patient involved in a fall opens eyes to pain, says random words, and shows no purposeful movement. What is his GCS?
6
97. A 22-year-old female overdose patient has her eyes open, is not speaking, and withdraws from painful stimuli. What is her GCS?
9
98. A 34-year-old male opens eyes only to pain, makes incomprehensible noises, and flexes abnormally to pain. What is his GCS?
6
99. A 48-year-old female after trauma opens eyes to speech, is confused, and shows purposeful movement to pain. What is her GCS?
11
100. A 67-year-old male opens his eyes when spoken to, responds with inappropriate words, and follows simple motor commands. What is his GCS?
12
Final Thoughts
The Glasgow Coma Scale is a simple yet powerful tool that enables healthcare professionals to rapidly assess and monitor a patient’s level of consciousness in a consistent and objective way. By evaluating eye, verbal, and motor responses, the GCS provides critical insights that influence clinical decisions and treatment strategies.
Although it’s not without its challenges, especially in specific patient populations, the scale continues to serve as an essential guide in both emergency and long-term care.
Understanding how to properly interpret and apply the GCS is a must for any clinician involved in the care of patients with potential brain injuries or altered mental status.
Written by:
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
References
- Jain S, Iverson LM. Glasgow Coma Scale. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.