What is the specific content of RLS consciousness score?

In clinical practice, the degree of damage to liver and kidney function can be detected by testing the patient's blood-related biochemical indexes, so as to accurately determine the degree of damage to liver and kidney function. However, it is difficult to make a quick and effective judgment on the severity of acute cerebral dysfunction. In clinical nursing care, the observation of consciousness usually adopts the pattern of "awake, drowsy, comatose". Although this method is also in line with the law of the development of consciousness disorder, it is not specific enough compared with the Reaction Leuel Scale (RLS). The Reaction Leuel Scale (RLS 85) is currently the best choice for rapid and effective determination of acute brain dysfunction. The use of RLS score can clearly reflect the degree of impaired consciousness and provide a reliable basis for the observation and care of critically ill patients.

The Reaction Leuel Scale (RLS), created by Swedish neurosurgeon starmark in 1985. It is commonly used in Scandinavia and is a reliable and easy method of assessing the level of consciousness.The RLS assessment method is very clear in its thinking. According to whether the patient has one of the four functions (verbal response, eye directed movement, compliant movement, removal of pain), quickly determine the patient's level of consciousness, distinguish between conscious response and coma two grades. rls*** is divided into 8 grades: rls 1 ~ 3 is a conscious response; rls 4 ~ 8 is a coma state.

The patients with conscious response are classified as awake, drowsy, and unconscious according to their different levels of response to speech and stimulus intensity.

For patients in coma, according to the patient's motor response to strong pain stimulation, the coma is classified from shallow to deep, in order of 4~8. RLS above level 5 is deep coma.

Conscious response: the organism is in an aroused state and exhibits at least one of the following four functions: verbal response, directional eye movement, compliant movement, and removal of pain.

Coma: is an unconscious response of the organism that fails to exhibit the functions defined in the conscious response. (RLS 4 to 8).

Mild stimulation: calling the patient's name, shaking the patient's shoulders, or rubbing the skin on the chest.

Strong painful stimuli: aspiration, or 5 seconds of firm pressure on the orbit, mastoid root, sternum, or fingernails.

1. Awake (RLS-1): clarity, no delay in response. Orientation is accurate and there is no drowsiness.

2. Drowsy or unconscious (RLS-2): observe response to light stimuli. Drowsiness: the patient is in a sleepy state with a mild delay in response. Indistinct consciousness: the patient is awakened and makes errors in answering at least one of the following three questions.1) What is your name? 2) Where are you? 3) What year and month is it?

3. Very lethargic or fuzzy consciousness (RLS-3): observe the response to strong stimuli.

4. unconsciousness (RLS-4): can localize pain but cannot remove it. Localization of pain: the body is in a prone position during the examination and the arms are placed on the side of the body. 1) Pressing on the root of the mastoid process, the patient's arm can be elevated above the chest; 2) pressing on the fingernail, the patient is able to move the other hand beyond the midline of the body.

5. Unconsciousness (RLS-5): There is avoidance of pain. Pain avoidance: 1) pressing on the mastoid root, the patient turns the face to face the opposite side; 2) pressing on the nail, the patient is unable to designate pain, but there is a marked retraction of the hand.

6. Stupor (RLS-6): flexion of the limbs during strong painful stimuli (decerebral cortical state). Flexion movements of the limbs: slow and mechanical flexion movements of the wrist and elbow joints in response to strong pain stimuli, but no localization or avoidance of pain.

7. Stupor ((RLS-7): dorsal extension of the limb in response to a strong pain stimulus (decerebrate state). Dorsiflexion of the limbs: obligatory dorsiflexion of the upper/or lower limbs in response to strong pain stimuli. If there is both flexion and dorsal extension, this should be recorded as RLS-6

8. Stupor (RLS-8): absence of body response to strong pain stimulation. No response to strong pain stimulation: the patient's upper and lower extremities and face do not respond to repeated administration of strong pain stimulation.

Each increase or decrease of 1 level in RLS is clinically significant. The health care provider can accurately understand the patient's state of consciousness and whether the craniocerebral injury has worsened by simply describing the pupils and RLS during continuous observation of the condition.

(Source: Department of Emergency Medicine, The First Affiliated Hospital of Kunming Medical College)