ARCHETYPE Richmond Agitation-Sedation Scale (RASS) (openEHR-EHR-OBSERVATION.rass.v0)

ARCHETYPE IDopenEHR-EHR-OBSERVATION.rass.v0
ConceptRichmond Agitation-Sedation Scale (RASS)
DescriptionThe Richmond Agitation-Sedation Scale (RASS) is a tool used to measure the agitation or sedation level of a patient.
UseUsed to record the result for the Richmond Agitation-Sedation Scale (RASS).
PurposeTo record the result for the Richmond Agitation-Sedation Scale (RASS).
ReferencesCurtis N. Sessler, Mark S. Gosnell, Mary Jo Grap, Gretchen M. Brophy, Pam V. O'Neal, Kimberly A. Keane, Eljim P. Tesoro, and R. K. Elswick "The Richmond Agitation–Sedation Scale", American Journal of Respiratory and Critical Care Medicine, Vol. 166, No. 10 (2002), pp. 1338-1344. doi: 10.1164/rccm.2107138

©Norsk oversettelse godkjent av Curtis Sessler november 2008 / Hilde Wøien, Hanne Alfheim, Anne Kathrine Langerud og Audun Stubhaug,
Anestesi- og Intensivklinikken Rikshospitalet HF

German translation from https://www.icu-rehab.de/resources/RASS.pdf
Copyright© openEHR Foundation, HiGHmed
AuthorsDate originally authored: 2025-02-04
Other Details LanguageDate originally authored: 2025-02-04
OtherDetails Language Independent{licence=This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/., custodian_organisation=HiGHmed, references=Curtis N. Sessler, Mark S. Gosnell, Mary Jo Grap, Gretchen M. Brophy, Pam V. O'Neal, Kimberly A. Keane, Eljim P. Tesoro, and R. K. Elswick "The Richmond Agitation–Sedation Scale", American Journal of Respiratory and Critical Care Medicine, Vol. 166, No. 10 (2002), pp. 1338-1344. doi: 10.1164/rccm.2107138 ©Norsk oversettelse godkjent av Curtis Sessler november 2008 / Hilde Wøien, Hanne Alfheim, Anne Kathrine Langerud og Audun Stubhaug, Anestesi- og Intensivklinikken Rikshospitalet HF German translation from https://www.icu-rehab.de/resources/RASS.pdf, original_namespace=org.highmed, original_publisher=HiGHmed, custodian_namespace=org.highmed, MD5-CAM-1.0.1=9CE1CEA72E41D8F092F338511EF8DF42, build_uid=c3ba67cb-1cb0-4d65-876a-8c47f53fc91a, revision=0.0.1-alpha}
Keywordsagitation, sedation, alertness, cognition,
Lifecyclein_development
UIDec16f63f-fd39-4dea-b57d-cacd63456771
Language useden
Citeable Identifier1246.145.2455
Revision Number0.0.1-alpha
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  • German: Carlotta Jöhnk, Universitätsklinikum Schleswig-Holstein, Germany, carlottapauline.joehnk@uksh.de
  • Norwegian Bokmål:
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3: Very agitated [Pulls on or removes tube(s) or catheter(s) or has aggressive behavior toward staff]
2: Agitated [Frequent nonpurposeful movement or patient–ventilator dyssynchrony]
1: Restless [Anxious or apprehensive but movements not aggressive or vigorous]
0: Alert and calm [Spontaneously pays attention to caregiver]
-1: Drowsy [Not fully alert, but has sustained (more than 10 seconds) awakening, with eye contact, to voice]
-2: Light sedation [Briefly (less than 10 seconds) awakens with eye contact to voice]
-3: Moderate sedation [Any movement (but no eye contact) to voice]
-4: Deep sedation [No response to voice, but any movement to physical stimulation]
-5: Unarousable [No response to voice or physical stimulation]
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