What does a RASS score of +4 indicate?

A RASS score of +4 indicates a very agitated or combative state. The Richmond Agitation-Sedation Scale (RASS) is a tool used to assess a patient's level of sedation and agitation. The scoring ranges from -5 (unalterable to external stimuli) to +4 (very agitated), with other values corresponding to varying levels of sedation and agitation.

In a clinical setting, a score of +4 reflects significant restlessness and may include behaviors such as pulling at tubes, thrashing, or being overtly combative. This level of agitation often poses challenges for care and safety, as such patients may not respond appropriately to verbal commands and may require additional interventions to ensure their well-being and that of the staff. Understanding this score is essential for effective patient management and for deciding on appropriate treatment measures that address safety and agitation.