AVPU is a simple clinical assessment tool used to describe a patient’s level of consciousness. The letters stand for: Alert (the patient is fully awake and aware of their surroundings), Voice (the patient responds to verbal stimulation but is not fully alert), Pain (the patient responds only to painful stimuli such as pressure or a sternal rub), and Unresponsive (no response to any stimuli). AVPU provides a rapid, standardised way to communicate a patient’s neurological status between healthcare professionals.
A patient who is Alert (A) has a normal level of consciousness. Responding only to Voice (V) indicates impaired consciousness; responding only to Pain (P) indicates significant impairment; and Unresponsive (U) equates to the deepest level of unconsciousness. The AVPU scale was incorporated into the NEWS2 scoring system as ACVPU, with ‘Confusion’ added as a fifth category to detect early cognitive deterioration as a warning sign.
In the context of cardiac arrest and post-arrest care, AVPU is used during the initial post-resuscitation assessment and in the intensive care unit to track neurological recovery as sedation is reduced. For more detailed assessment, the Glasgow Coma Scale (GCS) is used, as it provides more granular information about eye opening, verbal, and motor responses.
Families of cardiac arrest patients in intensive care may hear terms such as ‘responding to pain only’ or ‘unresponsive’. Understanding what the AVPU scale means helps families make sense of these descriptions and have more informed conversations with the clinical team about their loved one’s neurological status.
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