Have you heard another healthcare provider say something like this, “The patient is unconscious, breathing, and talking” and think, “Huh?”
To better understand a patient’s current level of consciousness and communicate that to other healthcare providers, EMTs and paramedics use the AVPU scale.
What does AVPU mean?
AVPU (pronounced as ave poo) acronym or the AVPU scale — a tool used to assess the patient’s brain perfusion and function — describes a patient’s level of consciousness. All healthcare providers, including EMTs, doctors, nurses and paramedics, use AVPU to assess and monitor a patient’s brain function.
- A = Awake. The patient is Awake
- V = Verbal. The patient responds to a Verbal stimulus
- P = Pain. The patient responds to a Pain stimulus
- U = Unresponsive. The patient is Unresponsive to stimulus
The distinction between ‘A’ and ‘V’ frequently causes confusion.
You are awake on AVPU scale
If you are reading this article, you are ‘A’ on AVPU. You might be awake and confused, awake and disoriented, awake and lethargic, or awake and oriented. Those descriptors for being awake, such as confused or disoriented, describe your mental status.
Awake patients are always conscious and some adjective which describes their mental status of being awake.
As a reader of this article, you are also likely alert and oriented.
What is alert and oriented x 4?
Another commonly used assessment and patient condition description tool is to describe an awake patient as “Alert and oriented x 4" or AOx4 (or 3, 2, 1). AOx4 has four components, which are:
- Person: The patient knows who they are.
- Place: The patient knows where they are.
- Time: The patient knows the approximate time.
- Event: The patient knows what they were doing leading up to their injury or illness.
The patient, depending on the severity of their condition, might only have partial recall of their name, time, place or events. Or only be able to accurately answer one or two of the questions. In that case, a patient might be AOx2 or AOx1, but in reality awake and confused might be a better way to describe the patient’s mental status.
Being not awake is unconscious
A patient who is not awake is unconscious. A patient who is unconscious is V, P, or U on the AVPU scale.
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’ or Awake.
A patient that is ‘V’ cannot be alert, answer SAMPLE history questions, describe their chief complaint or make an informed decision about refusing care.
Interpreting a pain stimulus
If the patient doesn’t respond to a verbal stimulus, attempt a pain stimulus with a pinch, squeeze or sternum rub.
A sternum rub is the application of a painful stimulus with the knuckles of a closed fist to the center chest of a patient who is not alert and does not respond to verbal stimuli. The sternum rub is the most common painful stimulus practiced in the field by EMTs and paramedics. However, it is possible to misinterpret the patient’s response to the stimuli depending on the duration the pressure is applied.
Glasgow Coma Scale
An alternative to the AVPU scale to assess a patient’s level of consciousness is the Glasgow Coma Scale.
How to use AVPU
Knowing the patient’s level of consciousness — A, V, P, or U — is the beginning of an investigation. If the patient is awake and has an altered mental status, use the focused history (SAMPLE, OPQRST) and physical exam to determine why. Does the patient have low blood sugar, other symptoms of a stroke, or signs of a narcotics overdose?
For a patient who is V, P, or U, there is increased urgency to determine the cause and provide treatment. For example, a patient who is unconscious may not be able to control their own airway. Seek out a cause and provide treatment within your scope of practice.
Finally, reassess AVPU during treatment and transport. Monitoring AVPU and other vital signs will help determine if the patient is improving, worsening or responding to treatment.
This article, originally published August 18, 2009, has been updated with additional information.
