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The AVPU acronym is a straight-forward scale that can be used to quickly assess a patient’s responsiveness and mental state. It is a simplified version of the Glasgow Coma Scale, paring the 13 point-based outcomes down to 4.

There are many potential causes for aberrations in a patient’s neurological functioning that could make them present with an altered state of consciousness. This could be due to drugs (legal or illegal), medication, poison, alcohol, brain injury, an underlying medical illness, lack of oxygen, and more.

To assess what the cause might be and how serious the situation is, the AVPU mnemonic is used extensively in various pre-hospital first-aid situations as well as within hospital wards and intensive care units.

AVPU is actually a set of criterion through which a patients’ responsivity and awareness can be assessed and categorized. It is a quick and simple method for identifying altered mental status within a patient, and requires no formal training to be used.

The AVPU acronym stands for:

A: Alert

Is the patient aware of the examiner and able to respond to them? Can they open their eyes spontaneously and visually track objects? Do they react to their environment independently and show awareness of their surroundings? If yes, they can be graded as ‘alert’.

An alert patient may show slight signs of confusion, fatigue, or disorientation but should be fully awake and lucid in responding to questions. Basic questions can be asked to evaluate their mental state, such as “What is today’s date?” “Do you know where you are?”, etc. Yes/no questions should be avoided, you want the patient to respond with some level of detail so that you can rate their ability to give specific answers.

V: Verbally Responsive

The patient is not opening their eyes spontaneously, but they will open their eyes or show some other response, e.g. moving a limb or making a small vocal grunt, when spoken to. If they can react to the verbal stimulus they receive in a direct and meaningful way, they can be graded as ‘verbally responsive’.

P: Painfully Responsive

If the patient is not opening their eyes spontaneously and will only open their eyes in response to painful stimuli applied by the examiner, which may cause them to directly respond with a cry or moan, they can be graded as ‘painfully responsive’ on the AVPU mnemonic scale.

U: Unresponsive

In this case, the patient is not responding spontaneously at all and shows no reaction to verbal or painful stimuli.

Any score lower than A or Alert should be treated as abnormal until proven otherwise (occasionally there may be another cause for a low score on the AVPU mnemonic scale that does not corroborate the suspected altered mental status, such as deafness).

Why is the AVPU Mnemonic Used?

As altered mental status is one of the strongest predictors of death on a hospital ward and the AVPU is quick and simple to carry out, it can be a very useful tool to help medical personnel identify high-risk patients quickly.

For example, the AVPU acronym and scale has been used successfully in the primary assessment of trauma patients, as their decreased mental status could indicate that an inadequate volume of oxygenated blood is reaching the brain. A drop in the AVPU score in a patient with AMS should be noted immediately and set anyone providing medical care on high alert.