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Emergency & Critical Care
RASS (Richmond Agitation Scale)

RASS — Richmond Agitation-Sedation Scale

Validated 10-level sedation/agitation scale for ICU patients — guides sedation management

Instructions: Observe the patient. Select the RASS level that best describes their current state. This is an observational scale — no input required beyond selecting the observed behaviour.
RASS Quick Reference
ScoreLevelDescription
+4CombativeViolent; immediate danger to staff
+3Very agitatedPulls tubes; aggressive
+2AgitatedFrequent nonpurposeful movement
+1RestlessAnxious, not aggressive
0Alert & calmNormal target
−1DrowsyEye contact >10 sec to voice
−2Light sedationEye contact <10 sec to voice
−3Moderate sedationMovement to voice, no eye contact
−4Deep sedationResponse to physical stim only
−5UnarousableNo response
RASS is observational — no formula
Standard targets: Mechanically ventilated = 0 to −2 | Procedure sedation = −2 to −3
Paired with CAM-ICU for delirium assessment (RASS ≥−2 required for CAM-ICU)
Sedation Protocol: Daily sedation awakening trials (SATs) target RASS 0 to −1. Over-sedation (RASS ≤−3) prolongs mechanical ventilation, ICU stay, and increases delirium risk. Propofol/dexmedetomidine preferred for light sedation. Benzodiazepines should be minimised (associated with delirium). Always re-assess pain before increasing sedation.
For clinical decision support only. Not a substitute for professional medical judgment.

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