Glasgow Coma Scale practice

Eye opening (E1 to E4)

E4Opens spontaneously

The eyes are already open as you walk up, or they open without you having to do anything. You are not asking for this, you are noticing it.

When you see it: Almost everyone you meet. They are awake and their eyes are already open.

E3Opens to voice

The eyes are closed until you speak, then they open. Try a normal voice first, then a raised one.

When you see it: Someone drowsy but rousable. Low blood sugar, too much to drink, a knock on the head, waking from a faint.

E2Opens to pain

Speaking does nothing. The eyes open only when you apply a painful stimulus.

When you see it: Someone you cannot wake by talking. A head injury, a poisoning or overdose, a bad infection in an older person.

E1No eye opening

The eyes stay closed to voice and to pain. If swelling is holding them shut, say so when you report the score rather than scoring the swelling as a 1.

When you see it: Someone who is out. Cardiac arrest, a serious overdose, a serious head injury.

Verbal response (V1 to V5)

V5Oriented

They can tell you who they are, where they are, roughly what time or day it is, and what happened. All four.

When you see it: Anyone holding a normal conversation with you.

V4Confused

They talk with you in sentences you can follow, but they get one of those four wrong. Someone chatting away normally who has the month wrong is confused, not oriented.

When you see it: A head injury, low blood sugar, an infection in an older person, alcohol. They talk, but they have lost track of something.

V3Inappropriate words

Real words, but not a conversation. Calling out, swearing, single words that do not answer what you asked.

When you see it: The same causes, further along. Words come out but they do not answer you.

V2Incomprehensible sounds

Sounds without words. Groaning, moaning, mumbling.

When you see it: Someone you can barely rouse. All you get is a moan.

V1No verbal response

Nothing at all, including to a painful stimulus.

When you see it: Cardiac arrest, or anyone else who is completely out.

Motor response (M1 to M6)

M6Obeys commands

They do what you ask, and the asking can be ordinary. Can I have your wrist to check your pulse. Can you shuffle your chair round so I can see you. Most of the time you have already scored this before you thought about scoring it, because they did something you asked while you were still introducing yourself.

When you see it: Anyone who does what you ask, including without noticing they were asked.

M5Localizes to pain

Squeeze the trapezius and their hand comes up and pushes or swats yours away. They have found the source and gone for it.

When you see it: Out cold, but still defending themselves.

M4Withdraws

Squeeze the trapezius and they roll their body away from you. They are getting away from it rather than going for it.

When you see it: Deeper again. They move away from what hurts but no longer go after it.

M3Flexes (Decorticate)

Decorticate. The arms bend up and in towards the chest and the wrists curl. Flexion.

When you see it: A serious brain injury. A hard knock in a fight, a bad fall, a stroke, or the minutes after a cardiac arrest. Their eyes stay shut and the arms curl up when you hurt them.

M2Extends (Decerebrate)

Decerebrate. The arms straighten out rigid alongside the body. Extension, and it scores lower than flexion.

When you see it: The same kinds of causes, worse. You have seen this on a football field or in a fight after a bad knockout: the arms go straight and rigid.

M1No motor response

No movement of any kind, in any limb, to a painful stimulus.

When you see it: Someone found unresponsive and simply not moving. No sounds, no posturing, nothing at all when you hurt them. Cardiac arrest is the common one.

The ones people mix up