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Part of NREMT Skillset
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Type Medical skill
Keywords medical, trauma
Aliases psychological
Published by Emilio Velis
Published 2020
License CC BY-SA 4.0
  • 0:18 Alert
  • 0:57 Verbal
  • 2:23 Pain
  • 2:58 Unresponsive

The AVPU scale is a rapid method of assessing LOC. The patient's LOC is reported as A, V, P, or U.

A: Alert. The patient is awake, and looking around and readily responds to questions or initiates conversation. NOTE: Anything below Alert is unconscious; from there we need to determine how unconscious the patient is. A patient can be unconscious with response to stimuli or unresponsive.

V: Responds to Verbal stimulus. This indicates that your patient only responds when verbally prompted. It is also important to note if the patient makes appropriate or inappropriate responses. If you ask your patient, "What is your name?" and he responds with, "I don't know" or a non-sequitur like "dancing turtles" this would be an inappropriate response and shows that although he responds to verbal, he is not appropriately oriented. Note if the response is to normal or loud voice stimuli, and take into consideration that the patient may have impaired hearing. Deafness should not be considered an altered level of consciousness.

P: Responds to Pain. Test this only if the patient does not respond to verbal stimuli. Gently but firmly pinch patient's shoulder, or rub their sternum. Note if patient moans or withdraws from the stimulus.

U: Unresponsive. If the patient does not respond to painful stimulus on one side, try the other side. A patient who remains flaccid without moving or making a sound is unresponsive.

If the patient is not alert, evaluate them on the Glasgow Coma Scale. The Glasgow Coma Scale is an assessment based on numeric scoring of a patient's responses based on the patient's best response to eye opening, verbal response, and motor response. The patient's score (3 to 15) is determined by adding his highest eye opening, verbal response, and motor response scores.