Have you heard, 鈥淭he patient is unconscious, breathing, and talking鈥 and thought, 鈥淗uh?鈥
AVPU (pronounced as ave poo) or the AVPU scale 鈥 a tool used to assess the patient鈥檚 brain perfusion and function 鈥 describes a patient鈥檚 level of consciousness. All healthcare providers, including EMTs, doctors, nurses and paramedics, use AVPU to assess and monitor a patient鈥檚 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 鈥楢鈥 and 鈥榁鈥 frequently causes confusion.
You are awake on AVPU scale
If you are reading this article, you are 鈥楢鈥 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 鈥榁鈥 responds to a verbal stimulus provided by responders.
Have you ever yelled, 鈥淒UDE, wake up!鈥 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, 鈥淲hy are you yelling at me?鈥 the patient is 鈥楢鈥 or Awake.
A patient that is 鈥榁鈥 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鈥檛 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鈥檚 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鈥檚 level of consciousness is the Glasgow Coma Scale.
How to use AVPU
Knowing the patient鈥檚 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.
This article, originally published August 18, 2009, has been updated with additional information.