a. AVPU. The AVPU scale is a rapid method of assessing LOC. The patient's
LOC is reported as A, V, P, or U.
A: Alert and oriented.
(a) Signifies orientation to person, place, time, and event. Ask your
patient simple open ended questions that can not be answered with yes or no to
determine the LOC. For example, "Where are you right now?" and "What time is it?"
Do not ask your patient, "Do you know were you are right now?" since this can be
answered with a yes or no.
(b) If the patient is alert, you can reported your results as a patient
oriented score from 1 (lowest) to 4 (highest), noting any areas not oriented to. For
example, you can state the patient is "A and O X 4" (fully alert and oriented) or "A and O
x 2 and does not know time and place."
(2) 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, "Flaming monkeys," this would be an inappropriate response and
shows that although he responds to verbal, he is not appropriately oriented.
(a) Response to normal voice stimuli.
(b) Response to loud voice stimuli.
P: Responds to pain.
(a) Use if patient does not respond to verbal stimuli.
(b) Gently but firmly pinch patient's skin.
Note if patient moans or withdraws from the stimulus.
If the patient does not respond to painful stimulus on one side, try
the other side.
(b) A patient who remains flaccid without moving or making a sound is
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.
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