Grading Scales Flashcards
Grade 1 Concussion
- No loss of consciousness
- Some transient confusion by pt
- Symptoms resolve within 15 min
- Pt may have full memory of the event
- Athlete should be removed from the competition
- Return to play: Athlete must be symptom free after 1 week of rest.
Grade 2 Concussion
- Moderate head injury with transient confusion lasting longer than 15 min
- Poor concentration
- Retrograde or anterograde amnesia
- Athlete should be removed immediately from the competition and receive medical evaluation.
- CT scan indicated if symptoms worsen.
- Return to play: Athlete must be asymptomatic for 2 weeks at rest AND with exertion.
Grade 3 Concussion
- Head injury with any form of loss of consciousness.
- Transport pt to ER for full neurological evaluation.
- Hospitalization indicated if altered consciousness or mental status persists.
- Return to play: Athlete must be symptom free for minimum of one month.
Name the RLA Levels (1-8)
I. No Response
II. Generalized Response
III. Localized Reponse
IV. Confused-Agitated
V. Confused-Inappropriate
VI. Confused-Appropriate
VII. Automatic-Appropriate
VIII. Purposeful-Appropriate
RLA I
No Reponse:
- Pt appears to be in a deep sleep
- Completely unresponsive to any stimuli
RLA II
Generalized Response:
- Pt reacts inconsistently and non-purposefully to stimuli
- Non-specific responses
- Responses often the same regardless of stimulus presented
- Responses may be physiological changes, gross body movements, and/or vocalization.
RLA III
Localized Response:
- Pt reacts specifically but inconsistently to stimuli
- Responses directly related to type of stimulus presented
- May follow simple commands such as closing eyes or squeezing the hand in an inconsistent and delayed manner.
RLA IV
Confused-Agitated:
- Heightened state of activity
- Bizarre, non-purposeful behavior
- Does not discriminate among persons or objects
- Unable to directly cooperate with treatment efforts
- Verbalizations incoherent or inappropriate for the environment.
- Confabulation
- Very brief gross attention to environment
- Non-existent selective attention
- Lack of short and long term recall
RLA V
Confused-Inappropriate:
- Responds to simple commands.
- Non-purposeful, random responses to complex, multi-step commands.
- Highly distractable
- Lack of attentional focus.
- Can converse on a social automatic level
- Inappropriate and confabulatory speech
- Memory severely impaired
- Inappropriate use of objects
- Inability to learn new information
RLA VI
Confused-Appropriate:
- Goal-directed behavior dependent on external input or direction.
- Consistently follows simple directions
- Shows carry-over for relearned tasks
- Responses may be incorrect due to memory issues but are appropriate for the situation.
- Past memories show more depth and detail than recent memories.
RLA VII
Automatic-Appropriate:
- Pt appears appropriate and oriented in hospital and home settings.
- Goes through daily routine automatically
- Robot-like
- Minimal to no confusion
- Shallow recall of activities
- Show carry over for new learning, just slower
- Can initiate structured social or recreational activities
- Impaired judgement
RLA VIII
Purposeful-Appropriate:
- Able to recall and integrate past and recent events
- Aware of and responsive to environment
- Shows carry over for new learning
- Needs no supervision once activities are learned
- Decreased ability for abstract reasoning, tolerance to stress, and judgement in emergencies and unusual circumstances.
Glasgow Coma Scale
- Used to determine arousal and cerebral cortex function
- Categories: Eyes, Motor, Verbal
- Total score from 3-15 points
- Severe brain injury or coma: <8 (total)
- Moderate brain injury: 9-12
- Mild brain injury: 13-15
GCS: Eye opening
Spontaneous - 4
To speech - 3
To pain - 2
Nil - 1
GCS: best Motor response
Obeys commands - 6
Localizes pain - 5
Withdraws - 4
Abnormal flexion - 3
Extensor response - 2
Nil - 1
