Have you heard, "The patient is unconscious, breathing, and talking" and also thought, "Huh?"

AVPU (pronounced as ave poo) or the AVPU scale — a tool provided to assess the patient"s brain perfusion and role — defines a patient"s level of consciousness. All health care providers, including EMTs, doctors, nurses and paramedics, usage AVPU come assess and monitor a patient"s mind function.

What does AVPU mean? 


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A = Awake. The patient is Awake

V = Verbal. The patience responds to a Verbal stimulus

P = Pain. The patient responds to a Pain stimulus 

UUnresponsive. The patience is Unresponsive to stimulus 

The distinction between "A" and "V" frequently causes confusion.

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You are awake top top AVPU scale

If you are analysis this article, you space "A" top top AVPU. You could be awake and confused, awake and disoriented, awake and also lethargic, or awake and also oriented. Those descriptors for awake, such as perplexed or disoriented, describe your mental status. 

Awake patient are always conscious and some adjective that defines their mental status of gift awake.

Being not Awake is unconscious

A patient that is no awake is unconscious. A patient that is unconscious is V, P, or U on the AVPU scale.

A patient the is "V" responds to a verbal stimulus provided by responders.

Have you ever before yelled, "DUDE, wake up!" come an intoxicated patience (or friend) and they raised their eyes, looked at you, or in which method responded to her voice? They room responding come a verbal stimulus.

If the patience responds, "Why space you yelling in ~ me?" the patience is "A" or Awake.

A patient the is "V" cannot be alert, price SAMPLE history questions, explain their chef complaint or make an informed decision around refusing care.

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Interpreting a pain stimulus 

If the patience doesn"t respond come a verbal stimulus attempt a pains stimulus v a pinch, squeeze out or sternum rub. 

A sternum rub is the application of a painful stimulus with the knuckles of a closed fist to the center chest the a patient who is no alert and does not respond to linguistic stimuli. The sternum rub is the most common painful stimulus exercised in the ar by EMTs and paramedics. However, the is feasible to misinterpret the patient’s an answer to the stimuli relying on the expression the press is applied. 

Learn exactly how to correctly apply and also interpret a sternum rub. 

Glasgow Coma Scale

An different to the AVPU scale to evaluate a patient"s level of awareness is the Glasgow Coma Scale. 

How to usage AVPU

Knowing the patient"s level of consciousness - A, V, P, or U - is the start of an investigation. If the patient is awake and also has transformed mental standing use the focused background (SAMPLE, OPQRST) and also physical test to determine why. Walk the patient have low blood sugar, other symptoms of a stroke, or indications of a medicine overdose? 

For a patient that is V, P, or U, there is boosted urgency to recognize the reason and administer treatment. Because that example, a patient that is unconscious might not be able to control their own airway. Seek out a reason and administer treatment within her scope the practice. 

Finally, reassess AVPU throughout treatment and transport. Surveillance AVPU and also other an important signs will aid determine if the patience is improving, worsening or responding to treatment.


Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the initiatives of the editorial team top top Police1, FireRescue1, Corrections1 and lifwynnfoundation.org.Gregserved as the lifwynnfoundation.org editor-in-chief for five years. He has actually a bachelor's degree from the university of Wisconsin-Madison and a master's degree from the university of Idaho. That is one educator, author, nationwide registry paramedic due to the fact that 2005, and a long-distance runner. Greg to be a 2010 recipient of the EMS 10 Award for innovation. He is additionally a three-time Jesse H. Neal compensation winner, the most prestigious compensation in dedicated journalism,and the 2018 Eddie award winner for ideal Column/Blog. Affix with Greg top top Twitter or LinkedIn and also submit an article idea or ask inquiries with this form.