The Richmond Agitation and Sedation Scale (RASS) is one of several sedation/agitation scales most often used, but not limited to the ICU setting. The RASS covers the spectrum of states ranging from COMA (-5) to COMBATIVE (+4). It is the first step in the CAM-ICU tool used fo identify delirium in the ICU.
+4 : Combative
+3 : Very agitated
+2 : Agitated
+1 : Restless
0 : Alert and Calm
-1 : Drowsy
-2 : Light Sedation
-3 : Moderate Sedation
-4 : Deep Sedation
-5 : Unarousable