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Coma Diagnosis
Diagnosing a Coma
The depth of the coma is usually measured in the emergency and intensive care settings using a Glascow coma scale. The scale (from 3 to 15) assesses eye opening, verbal response, and motor response. A high score indicates a greater amount of consciousness and awareness.
In rehabilitation settings, another measurement scale is often used to indicate a patient's level of response and ability to function. It is called a Rancho scale and is named for the rehabilitation hospital where it was created, Rancho Los Amigos, in California.
Rancho scales are based on how the patient reacts to external stimuli and the environment. The scales consist of eight different levels and each patient will progress through the levels with starts and stops, progress and plateaus. A brief summary of the components of the Rancho scale include the following:
1
Level I |
1
No Response |
1
The patient is in a deep coma and appears soundly asleep; absence of any response to stimuli. |
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Level II |
1
General Response |
1
The patient responds to pain or repeated stimuli with non-purposeful movements or increased activity. |
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Level III |
1
Local Response |
1
The patient's response is more specific, such as turning the head toward a sound or following a simple command. Responses are delayed and inconsistent. |
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Level IV |
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Confused - Agitated |
1
The patient is in a heightened state of response, confused, agitated, attempts to pull out tubes, bites, hits, or kicks caregivers. Behavior is inappropriate and speech is often incoherent. |
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Level V |
1
Confused - Inappropriate - Not agitate |
1
The patient appears alert and can follow simple commands. Responses are confused and non-purposeful. Memory is impaired and speech is often inappropriate. |
1
Level VI |
1
Confused - Appropriate |
1
The patient shows purposeful behaviors but requires direction and supervision for activities such as dressing and eating; becoming more aware of the environment; memory improving. |
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Level VII |
1
Automatic - Appropriate |
1
The patient goes about activities appropriately with minimal confusion, but often appears "robot-like." Judgment, thinking, and problem solving remain impaired. |
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Level VIII |
1
Purposeful - Appropriate |
1
The patient is oriented with improving memory and skills. May still require supervision due to impaired cognitive ability. |
Neurocritical Care Program
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