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:  Alert: The patient is fully awake although not necessarily oriented. This patient will have spontaneously open 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. 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 , such as a central pain stimulus like a sternal rub or a peripheral stimulus such as squeezing the fingers.
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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. 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. 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.
Levels of Response AVPU:
The AVPU has only one of four possible outcomes: 1. Alert Patient is fully awake though not necessarily orientated , will have spontaneously open eyes, and will respond to voice thought may be confused. They will have bodily motor function. Voice The patient makes some sort of response when you talk to them. This could be through the eyes, which open when you speak to them, or by voice which may only be as little as a grunt. Or, it could be by moving a limb when prompted to do so by the rescuer. Pain A patient may respond by using any of the three components when pain stimulus is used on them Eyes, Voice, Movement.