Coma

Key elements of examination

Vital signs and breathing pattern

Cardiac rhythm

Response to voice

Eyes: open?, pupils, movements (spontaneous, doll’s), corneals

Grimace to q-tip in nose

Gag

Motor response to pain

Tone (lift arm, then drop)

Reflexes

Glasgow coma scale

points	eye opening	verbal	motor
6			obeys
5		oriented	localizes pain
4	spontaneous	confused	withdraws to pain
3	to speech	inappropriate	flexion (decort.)
2	to pain	unintelligible	extension (decereb.)
1	none	none	none

source: Flaherty A (1998) MGH Handbook of Neurology,