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Ramsay sedation scale

Score 1 2 3 4 5 6 Response Anxious or restless or both Cooperative, orientated and tranquil Responding to commands Brisk response to stimulus Sluggish response to stimulus No response to stimulus

Motor activity assessment scale


Score Level of sedation Examples of type of Response to complex stimulation motor activity Patient pulling at tubes or catheters or No external stimulus Does not thrashing required to elicit calm down from side to movement. when asked. side or striking at staff or trying to climb out of bed. Response to command Does not consistently obey Patient commands No external stimulus attempts to (eg will lie required to elicit sit up and down when movement. moves limbs asked but out of bed. soon reverts to attempts to sit up) No external stimulus Obeys Patient is required to elicit commands. picking at

Dangerously agitated and uncooperative.

Agitated.

Restless but cooperative

Calm and cooperative

Responsive to touch or name

sheets or tubes or movement. uncovering self. Patient No external stimulus Obeys adjusts sheets required to elicit commands. or clothes movement. purposefully. Opens eyes or raises eyebrows or turns head toward stimulus or moves limbs when touched or name is loudly spoken. Opens eyes or raises eyebrows or turns head toward stimulus or moves limbs in response to noxious stimulus (tracheal suctioning or 5 secs of vigorous orbital, sternal or nailbed pressure) Does not move with noxious stimulus

Responsive only to noxious stimuli

Unresponsive

Sedation-agitation scale
Score 7 6 5 4 3 2 1 Level of sedationResponse agitation Pulling at endotracheal tube, thrashing, climbing over bed Dangerous agitation rails Very agitated Does not calm, requires restraints, bites endotracheal tube Agitated Calm and cooperative Sedated Very sedated Unarousable Attempts to sit up but calms to verbal instructions Obeys commands Difficult to rouse, obeyss simple commands Rouses to stimuli. Does not obey commands Minimal or no response to noxious stimuli

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