Blunted reflex to light is an important manifestation of impaired consciousness or coma In the case of impaired consciousness or coma, physical examination cannot be done exhaustively, but emphasis should be placed on being quick and accurate. The state of consciousness should be rapidly determined with or without impairment of consciousness as well as clinical classification and grading. Vital signs in patients with blunted light reflexes: 1. Temperature: An increase suggests an infectious or inflammatory disorder. Excessive elevation may indicate heat stroke or brainstem damage. A low temperature suggests shock, ventricle III tumor, hyperalgesia, frostbite, or sedation overdose. 2.Inconsistent pulse: Possible heart disease, weakness suggests shock or internal bleeding, etc. Tachycardia may be shock, heart failure, hyperthermia or hyperthyroidism crisis. Too slow suggests increased intracranial pressure or A-Syndrome. 3. Respiration: Deep and fast regular respiration is common in diabetic acidosis and is called Kussmual respiration. Shallow and rapid regular respiration is seen in respiratory failure caused by shock, cardiopulmonary disorders or sleeping drug intoxication. Damage to the mesencephalon and upper midbrain often causes tidal breathing (Cheyne-Stokes breathing). Damage to the lower part of the midbrain and upper part of the pontine brain causes long inspiratory breaths. Damage to the lower pontocerebrum and upper medulla causes ataxic or nodding respiration. 4. High blood pressure: Suggests increased intracranial pressure, hypertensive encephalopathy, or cerebral hemorrhage. Too low may be burns, dehydration, shock, syncope, hyperalgesia or deep coma state. 5. Odor: The smell of alcohol is acute alcoholism. Liver odor indicates liver coma. Apple smell indicates diabetic acidosis. Garlic smell for dichlorvos poisoning. Urine odor (ammonia smell) suggests uremia. 6, neurological system: focus on the examination of meningeal stimulation signs and cone bundle signs, including cervical ankylosis, Kernig and Lasegue signs, Babinski’s sign, etc.. Fever with meningeal irritation signs often indicates central nervous system infection. The presence of meningeal irritation without fever is seen in subarachnoid hemorrhage. Hemiparesis is most often seen in cerebrovascular disease or intracranial tumors. Damage to different parts of the brainstem is determined from respiration, pupillary changes, eye movements (dollhead test), and motor responses. 7. Skin mucosa: Yellow staining may be hepatic coma or drug toxicity. Cyanosis is mostly cardiopulmonary disorders. Excessive sweating suggests organophosphorus toxicity, hyperthyroidism crisis or hypoglycemia. Pallor is seen in shock, anemia or hypoglycemia. Flushing is for atropine poisoning, hyperthermia, carbon monoxide poisoning, etc. Large subcutaneous petechiae may be thoracic crush injury syndrome. Facial yellow tumors may suggest tuberous sclerosis combined with seizures.