AVPU: Mental Status Examination

AVPU is simply one of many memory aids used to help health care provider students such as emergency medical technicians (EMTs) to remember the many things they must learn during training. AVPU stands for: alert, verbal, painful response, and unresponsive. It's an easy way to keep these four levels of responsiveness in mind when performing a mental status examination. AVPU might be called a mini mental status exam that can be performed very quickly. An unconscious patient as well as a patient with an altered mental status is cause for great concern to health care providers. While it's generally easy to determine a patient's level of responsiveness, there are times when AVPU comes in handy. Again, it's a memory aid for students; some find it helpful, others do not. During my EMT training, I used all of the memory aids available.

AVPU in Action

How exactly would AVPU be used in a real life scenario? It would probably be best to simply describe what might be seen for each level of consciousness. For example, A for alert would be the level of responsiveness for a patient who is awake, oriented to person, place, and time; and who can respond intelligently to the health care provider's questions.

The letter V for verbal would be the level of consciousness assigned to a patient who is not "awake" or alert, but who can and will respond to verbal stimuli. Talking or shouting at them evokes a response even if it's only a twitching of the eyelid, movement of a limb, or the making of a facial expression. The letter P for painful response denotes an even lower level of responsiveness than "verbal." A patient only responds to some type of painful stimuli such as pinching a finger or briskly rubbing the his or her sternum (breast bone). The mental status examination with AVPU ends with the letter U for unresponsive, the lowest level of responsiveness and the one considered the most dangerous.

Determining a patient's level of responsiveness is very important no matter whether the memory aid AVPU is used. A depressed state of consciousness or an altered mental status might be an indicator of a life-threatening condition such as insufficient oxygen being delivered to the brain. Some emergency medical services (EMS) systems also include testing a patient's orientation to person, place and time. A patient can be oriented to person, but not to place or oriented to person and place, but not to time. Simple questions help to determine if they have an altered mental status.

Source:

National Registry of Emergency Medical Technicians (NREMT) certification, EMT state license, EMT with local fire department