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Mental Status Exam
 
 

Sedation

 
 
 
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Richmond Agitation-Sedation Scale

A scale used to assess level of sedation, mainly in ICU patients.
  • Interpretation

  • +4
    Combative: violent, immediate danger to staff
  • +3
    Very agitated: pulling or removing tubes; aggressive
  • +2
    Agitated: Frequent non-purposeful movements; fights ventilator
  • +1
    Restless: anxious without aggressive or vigorous movement
  • 0
    Alert and calm
  • -1
    Drowsy: Not alert, but sustained eye contact to voice (>10 seconds)
  • -2
    Light sedation: briefly awakens with eye contact to voice (<10 seconds)
  • -3
    Moderate sedation: movement or eye opening to voice with no eye contact
  • -4
    Deep sedation: no response to voice, movement or eye opening to physical stimulation
  • -5
    Unrousable: no response to voice or physical stimulation
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