---
title: "Coma"
url: https://mghmclean.org/residents/handbk/part2b/coma.htm
description: "Eyes: open?, pupils, movements (spontaneous, doll’s), corneals"
published: 2026-08-10
updated: 2026-08-10
---

# Coma

Published 2026-08-10

PART 3 / CH 31

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,