AVPU scoring systemThe method we use for assessing the level of a patient’s disability or mental capacity is a system called AVPU or A-V-P-U. It’s an acronym we use to basically be able to assess a patient’s mental capacity and how alert they are. We need to do this early day because the whole idea of the AVPU scoring system is to see what condition the patient is in when we arrive and then when we treat the patient, we need a baseline set of observations to see what our treatment is achieving. Are we getting better or are we getting worse? Is the patient improving or is the patient deteriorating? And unless we have a baseline of basically a system to decide this or to decipher this from, then the whole process doesn’t make sense, it doesn’t work. We need to know the condition of the patient’s getting better and if it isn’t, why?

So “A”, “A” stands for alert. If we approach a patient, whether again, in a car crash, whether in their front room or in bed, are they alert? When I talk to them, do they talk back to me and how do they talk back to me? Do they speak properly? Do they speak clearly? And are they actually answering the question that I’ve asked in a concise and proper manner? In other words, is their brain function alert? Are they alert and are they actually doing what I’m asking them to do?

If they drop below alert, they drop then to voice, “V” on the AVPU scale. Voice basically means that the patient is not actually quite with us. They may be asleep, they may be a little bit dozy or less alert. So, as we talk to this patient, they then actually spark up or respond to us in some way or other, but they’re not quite as good as they were I.e., on the alert scale, or alert “A” on the AVPU scale. So, “V” is the next level down.

Then, we move to pain. Pain stimulus is created with a little squeeze at the back of the nail or a little squeeze into the earlobe itself, which are both very sensitive areas. So, if we squeeze quite hard, most people will react to that pain. They may not talk to us, they may not respond in any other way other than pulling away from the pain or reacting to the pain stimulus that we’ve just created. If they react to that, they have dropped down the scale again, they’re now reacting to pain. If we don’t get anything with pain, we move on to the unresponsive casualty.

Now, with pain, we get no movement, no reaction whatsoever, and we’re now leaving or looking at a patient that is totally unresponsive. That unresponsive patient now basically falls into the field of a seriously ill or dangerous position. In other words, we have to maintain and monitor that patient very closely, because if we don’t, these are the patients that will occlude their airway with their tongue. That will occlude their airways with fluid. This patient’s, basically, life, is in your hands to control everything that’s going on. If we leave an unresponsive patient on their back, for instance, and they vomit or stomach contents regurgitates from their stomach, or their tongue slumps to the back of the throat, we come back to the patient and unfortunately, because we weren’t paying attention, they have died.

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  2. Felisia Profit

    Hello! I will be using this scale for a nursing school project. Do you know who developed the AVPU scale?

    1. Keith Sleightholm Article Author

      The APUV is a simplification of the Glasgow Coma Scale, which assesses a patient response in three measures: Eyes, Voice and Motor skills.

  3. Felisia Profit

    Thanks Keith!
    I’m trying to find out who developed it in case I need permission to use the scale.

    1. Keith Sleightholm Article Author

      It is an international scale that is a standard one used. You would not as far as we know need permission to use it and I am not sure who you would contact to ask.