# AVPU > Mediated Wiki article. Canonical URL: https://mediated.wiki/source/AVPU > Markdown URL: https://mediated.wiki/source/AVPU.md > Source: https://en.wikipedia.org/wiki/AVPU > Source revision: 1351905423 > License: Creative Commons Attribution-ShareAlike 4.0 International (https://creativecommons.org/licenses/by-sa/4.0/) Scale for level of consciousness The **AVPU scale** (an acronym from "alert, verbal, pain, unresponsive") is a system by which a health care professional can measure and record a patient's [level of consciousness](/source/Level_of_consciousness).[1] It is mostly used in emergency medicine protocols, and within [first aid](/source/First_aid). It is a simplification of the [Glasgow Coma Scale](/source/Glasgow_Coma_Scale), which assesses a patient response to different stimuli in three measures: eye opening, vocal response, and motor function. The AVPU scale should be assessed using these three identifiable traits, looking for the best response of each.[2] ## Meaning of the mnemonic The AVPU scale has four possible outcomes for recording (as opposed to the 13 possible outcomes on the [Glasgow Coma Scale](/source/Glasgow_Coma_Scale)). The assessor should always work from best (A) to worst (U) to avoid unnecessary tests on patients who are clearly conscious. The four possible recordable outcomes are:[2] - **Alert**: The patient is fully awake (although not necessarily oriented). This patient will have spontaneously opened eyes, will respond to voice (although may be confused) and will have bodily motor function. - **Verbal**: The patient makes some kind of response when you talk to them, which could be in any of the three component measures of eyes, voice or motor – e.g., patient's eyes open on being asked "Are you OK?". The response could be as little as a grunt, moan, or slight move of a limb when prompted by the voice of the rescuer. - **Pain**: The patient makes a response on any of the three component measures [on the application of pain stimulus](/source/Pain_stimulus), such as a central pain stimulus like a [sternal rub](/source/Sternal_rub) or a peripheral stimulus such as squeezing the fingers. A patient with some level of consciousness (a fully conscious patient would not require a pain stimulus) may respond by using their voice, moving their eyes, or moving part of their body (including [abnormal posturing](/source/Abnormal_posturing)). - **Unresponsive**: Sometimes seen noted as '[unconscious](/source/Unconsciousness)', this outcome is recorded if the patient does not show any eye, voice, or motor response to voice or pain. In [first aid](/source/First_aid), an AVPU score of anything less than A is often considered an indication to get further help, as the patient is likely to be in need of more definitive care. In the hospital or long-term healthcare facilities, caregivers may consider an AVPU score of less than A to be the patient's normal baseline.[3] In some [emergency medical services](/source/Emergency_medical_services) protocols, "Alert" can be subdivided into a scale of 1 to 4, in which 1, 2, 3 and 4 correspond to certain attributes, such as time, person, place, and event. For example, a fully alert patient might be considered "alert and oriented x 4" if they could correctly identify the time, their name, their location, and the event. EMS crews may begin with an AVPU assessment, to be followed by a GCS assessment if the AVPU score is below "A." ## Limitations The AVPU scale is not suitable for long-term neurological observation of a patient; in this situation, the [Glasgow Coma Scale](/source/Glasgow_coma_scale) is more appropriate. ## Comparison with other classification systems This section needs expansion with: More scales Rationale behind comparisons Citations Secondary sources. You can help by adding missing information. (December 2014) When compared to the [Glasgow Coma Scale (GCS)](/source/Glasgow_Coma_Scale) the AVPU classification of alertness has been suggested to correspond in the following manner: - Alert = 15 GCS - Voice Responsive = 13 GCS - Pain Responsive = 8 GCS - Unconscious/DOA = 3 GCS (Kelly, Upex and Bateman, 2004)[1] The AVPU scale can also be compared to the [Pediatric Glasgow Coma Scale (PGCS)](/source/Pediatric_Glasgow_Coma_Scale). The PGCS corresponds with the AVPU classification of consciousness in the following manner:[4] - Alert = 11–15 PGCS - Voice Responsive = 5–15 PGCS - Pain Responsive = 4–12 PGCS - Unconscious = 3–5 PGCS ## References 1. ^ [***a***](#cite_ref-Kelly_1-0) [***b***](#cite_ref-Kelly_1-1) Kelly, CA; Upex A; Bateman DN. (August 2004). ["Comparison of consciousness level assessment in the poisoned patient using the alert/verbal/painful/unresponsive scale and the Glasgow Coma Scale"](http://www.medscape.com/medline/abstract/15278081). *Annals of Emergency Medicine*. **44** (2): 108–113. [doi](/source/Doi_(identifier)):[10.1016/j.annemergmed.2004.03.028](https://doi.org/10.1016%2Fj.annemergmed.2004.03.028). [PMID](/source/PMID_(identifier)) [15278081](https://pubmed.ncbi.nlm.nih.gov/15278081). 1. ^ [***a***](#cite_ref-McNarry_2-0) [***b***](#cite_ref-McNarry_2-1) McNarry, AF; Bateman, DN (January 2004). ["Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow Coma scale"](http://www.medscape.com/medline/abstract/14687096). *Anaesthesia*. **59** (1): 34–7. [doi](/source/Doi_(identifier)):[10.1111/j.1365-2044.2004.03526.x](https://doi.org/10.1111%2Fj.1365-2044.2004.03526.x). [PMID](/source/PMID_(identifier)) [14687096](https://pubmed.ncbi.nlm.nih.gov/14687096). 1. **[^](#cite_ref-3)** ["FIRST AID training"](https://www.malarfirstaid.com/). Sunday, 8 August 2021 1. **[^](#cite_ref-4)** Hoffmann, Florian; Schmalhofer, Michael; Lehner, Markus; Zimatschek, Sebastian; Grote, Veit (March 2016). ["Comparison of the AVPU Scale and the Pediatric GCS in Prehospital Setting"](https://www.tandfonline.com/doi/abs/10.3109/10903127.2016.1139216). *Prehospital Emergency Care*. **20** (4): 493–498. [doi](/source/Doi_(identifier)):[10.3109/10903127.2016.1139216](https://doi.org/10.3109%2F10903127.2016.1139216). [PMID](/source/PMID_(identifier)) [26954262](https://pubmed.ncbi.nlm.nih.gov/26954262). [S2CID](/source/S2CID_(identifier)) [7671467](https://api.semanticscholar.org/CorpusID:7671467). Retrieved September 6, 2021. --- Adapted from the Wikipedia article [AVPU](https://en.wikipedia.org/wiki/AVPU) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/AVPU?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.