Determining Level of Consciousness

Have you heard, "The patient is unconscious, breathing, and talking" and thought, "Huh?"

The AVPU scale — a tool used to assess the patient's brain perfusion and function — describes a patient's level of consciousness. The distinction between 'A' and 'V' frequently causes confusion.

If you are reading this, you are 'A' on AVPU. You might be awake and confused, awake and disoriented, awake and lethargic, or awake and oriented. Awake patients are always awake and some adjective that describes their mental status of being awake.

A patient that is not awake is unconscious, V, P, or U. A patient that is 'V' responds to a verbal stimulus provided by responders. Have you ever yelled, "DUDE, wake up!" to an intoxicated patient (or friend) and they raised their eyes, looked at you, or somehow responded to your voice? They are responding to a verbal stimulus. If the patient responds, "Why are you yelling at me?" the patient is 'A.'

A patient that is 'V' cannot be alert, answer history questions, or describe their chief complaint.

About the author

Greg Friese is Editor-in-Chief of He is an educator, author, paramedic, and marathon runner. Ask questions or submit tip ideas to Greg by e-mailing him at

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