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Use AVPU scale to determine a patient’s level of consciousness

Monitoring AVPU and other vital signs will help determine if the patient is improving, worsening or responding to treatment


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

AVPU (pronounced as ave poo) 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

What does AVPU mean?

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 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.

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.

It may not be poor brain integrity that is causing a lack of response to a sternum rub, but an inadequate length of time the sternum rub 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 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.

Learn more about patient assessment
Use SAMPLE history to assess the patient’s complaint and make treatment decisions
OPQRST is an important part of patient assessment and the start of a conversation with the patient about their pain complaint
Memorization of acronyms does not necessarily translate to understanding; here’s a breakdown of what DCAP-BTLS means

This article, originally published August 18, 2009, has been updated with additional information.

Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on LinkedIn.