AVPU Scale Calculator

How does this AVPU scale calculator work?

This health tool helps the clinician evaluate the patient LOC in terms of awareness and response to stimuli. There are four categories in which the AVPU scale calculator puts the patient and the medical professional needs to choose one of them according to the individual situation.

The AVPU scale is a first hand system that aims to simplify the GCS Scale – Glasgow Coma Scale as a first aid measure of assessing level of consciousness. It focuses on eye, voice and motor skills based on different stimulations. There are four outcomes that make the mnemonic as presented below:

I Alert and oriented

Being alert means that the patient reacts to external environmental stimuli and is fully awake, sometimes confused but nevertheless awake and can identify people around.

The alert and oriented state is answered by simple questions such as: Where are you now? What time and date is it? To be avoided questions where the patient can answer with yes or no without detailing the answer.

The reporting of alert state can be done on a scale from 1 to 4, specifying the degree of detail the patient has reached in the answers.

II Verbal stimulus, voice answer

The patient only responds when verbally prompted, through questions and might not appear aware or fully awake beforehand.

These questions may be similar to those testing alertness but this time should be noted whether the answers are appropriate or inappropriate, with high chances of them being inappropriate and denoting a lack of orientation.

Also, there might not be a verbal answer exhibited but a movement of limbs or eyes. It is also important to see whether the verbal orientation is done to normal or loud voice stimuli.

III Responsive to pain

The patient will be stimulated using mild pain such as a central pain stimulus, stern rub or peripheral stimulus like pinching the ear or pressing a fingernail and the reaction needs to be observed.

First is to check whether the patient has a localizing reaction, feeling where the stimulus has been applied. Then the reaction can be of either opening eyes, moaning, talking or movement.

In terms of movement, there should be noted whether it is a voluntary or involuntary reaction, flexion or extension of a limb or total movement of the body away from the stimulus.

IV Unresponsive

This state should be considered when the patient is not awake, not answering to verbal or pain stimulating and remains flaccid, without moving or making any sounds, intelligible or not.

At the same time, there should be determined whether the patient is unconscious with response to stimuli or unresponsive.

AVPU and Glasgow coma scale

Once the evaluation has been done, if the conscious level is below A (Alert and oriented to a certain degree) then medical help is required. If there are any open injuries or fractures, these should also be addressed first hand.

If the patient is unconscious, then the vitals should be checked, with a priority on making sure the patient’s airway is not obstructed and that the patient is put in a recovery position. In terms of oxygen therapy, if an oximeter is available, anything below 94% should be put on oxygen supplementation.

Often, the AVPU assessment is used before the Glasgow coma scale evaluation and as a supplement to the LOC section in GCS. The professional looks at the best response in every stage but only the best response that is maintained.

The only limitation of the model is that it can only be used for a first basis evaluation and does not provide means for long term follow up on LOC or neurological status such as the Glasgow scale. As a comparison between the two, each of the four statuses is equivalent to the following number of GCS points:

■ Alert = 13 - 15 GCS

■ Voice Responsive =  9 - 12 GCS

■ Pain Responsive = 4 - 8 GCS

■ Unconscious = 3 GCS

References

1) Kelly CA, Upex A, Bateman DN. (2004) Comparison of consciousness level assessment in the poisoned patient using the alert/verbal/painful/unresponsive scale and the Glasgow Coma Scale. Ann Emerg Med; 44(2):108-13.

2) McNarry AF, Goldhill DR. (2004) Simple bedside assessment of level of consciousness: comparison of two simple assessment scales with the Glasgow Coma scale. Anaesthesia; 59(1):34-7.