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

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.

What does AVPU mean? 

A = the patient is Awake

V = the patient responds to a Verbal stimulus

P = the patient responds to a Pain stimulus 

U = 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, 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 conscious and some adjective that describes their mental status of being awake.

Being Not Awake is unconscious

A patient that 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.'

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

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 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. 

Learn how to correctly apply and interpret a sternum rub

Glasgow Coma Scale

An alternative to the AVPU scale to assess a patient's level of consciousness is the Glasgow Coma Scale

This article, originally published 8/18/2009, has been updated

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