- 同
- RASS、リッチモンド興奮・鎮静スケール
- 日本呼吸療法医学会の人工呼吸中の鎮静のガイドラインで推奨している鎮静レベルの評価法。
- 簡便なRamsay scaleの信頼性と妥当性の検証して、様々なスケールが模索され、2002年にRASSが提案された。
- 鎮静スケールをつけられない時間が生じるので、その空白の時間帯を補って持続的にみる意味では、BISなどを用いる脳波モニタリングを推奨している。
ステップ1
|
30秒間、患者を観察する。これ(視診のみ)によりスコア0〜+4を判定する。
|
ステップ2:
|
1)大声で名前を呼ぶか、開眼するように言う。
|
2)10秒以上アイ・コンタクトができなければ繰り返す。以上2項目(呼びかけ刺激)によりスコア -1〜-3を判定する。
|
3)動きが見られなければ、肩を揺するか、胸骨を摩擦する。これ(身体刺激)によりスコア-4、 -5を判定する。
|
- 0を中心に10段階に分かれていて、プラスでは興奮、マイナスでは鎮静が強いと評価する。
スコア
|
用 語
|
説 明
|
4
|
好戦的な
|
明らかに好戦的な、暴力的な、スタッフに対する差し迫った危険
|
3
|
非常に興奮した
|
チューブ類またはカテーテル類を自己抜去;攻撃的な
|
2
|
興奮した
|
頻繁な非意図的な運動、人工呼吸器ファイティング
|
1
|
落ち着きのない
|
不安で絶えずそわそわしている、しかし動きは攻撃的でも活発でもない
|
0
|
意識清明な
|
落ち着いている
|
-1
|
傾眠状態
|
完全に清明ではないが、呼びかけに10秒以上の開眼及びアイ・コンタクトで応答する
|
呼びかけ刺激
|
-2
|
軽い鎮静状態
|
呼びかけに10秒未満のアイ・コンタクトで応答
|
呼びかけ刺激
|
-3
|
中等度鎮静
|
状態呼びかけに動きまたは開眼で応答するがアイ・コンタクトなし
|
呼びかけ刺激
|
-4
|
深い鎮静状態
|
呼びかけに無反応、しかし、身体刺激で動きまたは開眼
|
身体刺激
|
-5
|
昏睡
|
呼びかけにも身体刺激にも無反応
|
身体刺激
|
参考
- http://www.icudelirium.org/docs/RASS.pdf#search=%27Richmond+Agitation+Sedation+Scale%27
WordNet
- take by attacking with scaling ladders; "The troops scaled the walls of the fort"
- a specialized leaf or bract that protects a bud or catkin (同)scale leaf
- an ordered reference standard; "judging on a scale of 1 to 10" (同)scale of measurement, graduated table, ordered series
- relative magnitude; "they entertained on a grand scale"
- size or measure according to a scale; "This model must be scaled down"
- the ratio between the size of something and a representation of it; "the scale of the map"; "the scale of the model"
- a measuring instrument for weighing; shows amount of mass (同)weighing machine
- a flattened rigid plate forming part of the body covering of many animals
- an indicator having a graduated sequence of marks
- (music) a series of notes differing in pitch according to a specific scheme (usually within an octave) (同)musical scale
- a thin flake of dead epidermis shed from the surface of the skin (同)scurf, exfoliation
- remove the scales from; "scale fish" (同)descale
- reach the highest point of; "We scaled the Mont Blanc" (同)surmount
- climb up by means of a ladder
- measure by or as if by a scale; "This bike scales only 25 pounds"
- measure with or as if with scales; "scale the gold"
- pattern, make, regulate, set, measure, or estimate according to some rate or standard
- disturbance usually in protest (同)excitement, turmoil, upheaval, hullabaloo
- the act of agitating something; causing it to move around (usually vigorously)
- a state of agitation or turbulent change or development; "the political ferment produced new leadership"; "social unrest" (同)ferment, fermentation, tempestuousness, unrest
- a mental state of extreme emotional disturbance
- a state of reduced excitement or anxiety that is induced by the administrative of a sedative agent
- the administration of a sedative agent or drug (同)drugging
- capital of the state of Virginia located in the east central part of the state; was capital of the Confederacy during the American Civil War (同)capital of Virginia
PrepTutorEJDIC
- 《しばしば複数形で》『てんびん』,はかり / てんびんのさら / 《重量を表す副詞[句]を伴って》…の目方(体重)がある / …‘を'てんびんではかる
- (蛇・魚類などの)うろこ / うろこ状の物;(ペンキ・さび・ふけなどの)爆片 / 〈魚など〉‘の'うろこを取る;…‘の'皮をはぐ / (…から)〈ペンキなどの薄泰〉‘を'そぎ取る《+『名』+『off』(『from』)+『名』》 / (…から)〈ペンキなどが〉かげ落ちる《+『off』(『from』)+『名』》
- 『段階』,等級,階級 / 『比率』,縮尺 / (物差しなどの)『目盛り』 / (目盛りの付いた)『物差し』;温度計,(各種の)スケール / 『規模』,スケール / 音階 / 記数法,…進法 / …‘を'よじ登る / (…に合わせて)…‘を'調整する《+『名』+『to』+『名』》 / …‘を'縮尺で製図(設計)する
- 〈U〉(激しく)ゆり動かすこと,かき混ぜること / 〈U〉(心の)動揺 / 〈C〉〈U〉扇動,アジ
- (鎮静剤で)落ち着かせること,鎮静状態
- リッチモンド,米国Virginia州の州都 / イングランドSurrey州の都市
Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2015/07/14 13:15:24」(JST)
[Wiki en表示]
Richmond Agitation-Sedation Scale is a medical scale used to measure the agitation or sedation level of a patient. It was developed with efforts of different practitioners, represented by physicians, nurses and pharmacists.[1][2]
The RASS can be used in all hospitalized patients to describe their level of alertness or agitation.[3] It is however mostly used in mechanically ventilated patients in order to avoid over and under-sedation. Obtaining a RASS score is the first step in administering the Confusion Assessment Method in the ICU (CAM-ICU),[4] a tool to detect delirium in intensive care unit patients.
The RASS is one of many sedation scales used in medicine. Other scales include the Ramsay scale, the Sedation-Agitation-Scale, and the COMFORT scale for pediatric patients.
Score
Score |
Classification |
(RASS) |
4 |
Combative |
Overtly combative or violent; immediate danger to staff |
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 |
|
-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 |
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
- ^ Stawicki SP "Sedation scales: Very useful, very underused", OPUS 12 Scientist, Vol. 1, No. 2 (2007), pp. 10-12.
- ^ Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Sessler CN, Dittus RS, Bernard GR. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003 Jun 11;289(22):2983-91.
- ^ "Monitoring Delirium in the ICU". ICUdelirium.org. Retrieved 2015-04-28.
UpToDate Contents
全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.
English Journal
- Impaired Arousal in Older Adults Is Associated With Prolonged Hospital Stay and Discharge to Skilled Nursing Facility.
- Yevchak AM1, Han JH2, Doherty K2, Archambault EG3, Kelly B3, Chandrasekhar R2, Ely EW2, Rudolph JL4.
- Journal of the American Medical Directors Association.J Am Med Dir Assoc.2015 Mar 2. pii: S1525-8610(15)00100-0. doi: 10.1016/j.jamda.2015.01.093. [Epub ahead of print]
- BACKGROUND: Poor cognitive function is associated with negative consequences across settings of care, but research instruments are arduous for routine clinical implementation. This study examined the association between impaired arousal, as measured using an ultra-brief screen, and risk of 2 adverse
- PMID 25744874
- Risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery.
- Kim HJ1, Kim DK1, Kim HY2, Kim JK1, Choi SW1.
- Clinical and experimental otorhinolaryngology.Clin Exp Otorhinolaryngol.2015 Mar;8(1):46-51. doi: 10.3342/ceo.2015.8.1.46. Epub 2015 Feb 3.
- OBJECTIVES: To identify the incidence and the risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery.METHODS: We retrospectively examined 792 patients aged ≥18 years who underwent general anesthesia for elective nasal surgery between July 2012 and August 2013
- PMID 25729495
- Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study.
- TEAM Study Investigators.
- Critical care (London, England).Crit Care.2015 Feb 26;19(1):81. doi: 10.1186/s13054-015-0765-4.
- INTRODUCTION: The aim of this study was to investigate current mobilization practice, strength at ICU discharge and functional recovery at 6 months among mechanically ventilated ICU patients.METHOD: This was a prospective, multi-centre, cohort study conducted in twelve ICUs in Australia and New Zea
- PMID 25715872
- The validity, reliability, responsiveness and applicability of observation sedation-scoring instruments for use with adult patients in the emergency department: A systematic literature review.
- Varndell W1, Elliott D2, Fry M3.
- Australasian emergency nursing journal : AENJ.Australas Emerg Nurs J.2015 Feb;18(1):1-23. doi: 10.1016/j.aenj.2014.07.001. Epub 2014 Aug 4.
- AIM: This paper reports a systematic literature review examining the range of published observational sedation-scoring instruments available in the assessment, monitoring and titration of continuous intravenous sedation to critically ill adult patients in the Emergency Department, and the extent to
- PMID 25103566
Japanese Journal
- 看護 人工呼吸器装着患者の鎮静評価への取り組み : RASSの導入と患者評価について
- 日本語版CAM-ICUフローシートの妥当性と信頼性の検証
- 古賀 雄二,村田 洋章,山勢 博彰
- 山口医学 63(2), 93-101, 2014-05-01
- … の日本語版CAM-ICUフローシートの評価を比較し,評価者間の信頼性を評価した.結果:評価対象者数は82名であり,DSM-IV-TRでのせん妄有病率は22.0%であった.興奮・鎮静度はRASS(Richmond Agitation Sedation Scale)-0.33~-0.28であった.DSM-IV-TRに対するリサーチナースとスタッフナースの日本語版CAM-ICUフローシート評価結果は,感度が78%と78%,特異度が95%と97%であった.日本語版CAM-ICUフロ …
- NAID 120005477824
- 日本語版CAM-ICUフローシートの妥当性と信頼性の検証
- 古賀 雄二,村田 洋章,山勢 博彰
- 山口医学 63(2), 93-101, 2014
- … 版CAM-ICUフローシートの評価を比較し,評価者間の信頼性を評価した.結果:評価対象者数は82名であり,DSM-IV-TRでのせん妄有病率は22.0%であった.興奮・鎮静度はRASS(Richmond Agitation Sedation Scale)-0.33~-0.28であった.DSM-IV-TRに対するリサーチナースとスタッフナースの日本語版CAM-ICUフローシート評価結果は,感度が78%と78%,特異度が95%と97%であった.日本語版C …
- NAID 130004897874
- 鎮静,鎮痛,筋弛緩 (特集 神経集中治療) -- (全身管理)
- 小田 泰崇,鶴田 良介
- 救急医学 = The Japanese journal of acute medicine 37(12), 1604-1610, 2013-11
- NAID 40019869024
Related Links
- RICHMOND AGITATION-SEDATION SCALE (RASS) Scale Label Description STEP 1 Level of Consciousness Assessment -4 DEEP SEDATION No response to voice, but movement or eye opening to physical ...
- 110812 Richmond Agitation Richmond Agitation –––– Sedation Scale: Sedation Scale: RASS RASS 0を中心に10 段階に分かれていて、プラスは興奮、マイナスは鎮静が強いと評価する。 スコア 用語 説明 +4 好戦的な 明らか ...
- Pearls/Pitfalls The Richmond Agitation and Sedation Scale (RASS) is a validated and reliable method to assess patients’ level of sedation in the intensive care unit. As opposed to the Glasgow Coma Scale (GCS), the RASS is not ...
★リンクテーブル★
[★]
Richmond Agitation Sedation Scale
[★]
Richmond Agitation Sedation Scale
[★]
- 1. (魚・は虫類の)うろこ。(チョウ・ガの)鱗粉。(皮膚の)鱗屑。薄片。(植物)芽鱗、鱗片。(動物)カイガラムシ。(金属を熱したときにできる)薄い酸化膜、スケール。(ボイラーややかんの内側にできる)湯垢。歯石。
- 2. 目盛り、定規、物差し、尺度、基準。(地図などの)縮尺比、縮尺目盛り。階級、等級。規模、スケール
- 3. はかり、てんびん
[★]
- 振動、動揺、拡販、かき混ぜ。心的動揺、気持ちの乱れ、興奮。熟慮、塾公、熱心な討論。世論喚起運動、煽動、アジテーション
- 関
- agitate, incite, instigate, restless, restlessness, stir, stirring
[★]