The AVPU scale is a system by which a first aid

First aid

First aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care...

er, ambulance crew or health care professional can measure and record a patient's responsiveness, indicating their level of consciousness.

It is a simplification of the Glasgow Coma Scale

Glasgow Coma Scale

Glasgow Coma Scale or GCS is a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment...

, which assesses a patient response in three measures - Eye

Human eye

The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...

s, Voice

Voice

Voice may refer to:* Human voice* Voice control or voice activation* Writer's voice* Voice acting* Voice vote* Voice message-In film:* Voice , a 2005 South Korean film* The Voice , a 2010 Turkish horror film directed by Ümit Ünal...

 and Motor skill

Motor skill

A motor skill is a learned sequence of movements that combine to produce a smooth, efficient action in order to master a particular task. The development of motor skill occurs in the motor cortex, the region of the cerebral cortex that controls voluntary muscle groups.- Development of motor skills...

s. The AVPU scale should be assessed using these three identifiable traits, looking for the best response of each.

Meaning of the mnemonic

The AVPU scale has only 4 possible outcomes for recording (as opposed to the 13 possible outcomes on the 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:

• Alert - a fully awake (although not necessarily orientated) patient. This patient will have spontaneously open eyes, will respond to voice (although may be confused) and will have bodily motor function.
• Voice - 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 okay?!". 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 when pain stimulus is used on them. Recognized methods for causing the pain stimulus include a Sternal rub (although in some areas, it is no longer deemed acceptable), where the rescuers knuckles are firmly rubbed on the breastbone of the patient, pinching the patient's ear
  Ear
  The ear is the organ that detects sound. It not only receives sound, but also aids in balance and body position. The ear is part of the auditory system....
  
   and pressing a pen
  Pen
  A pen is a device used to apply ink to a surface, usually paper, for writing or drawing. Historically, reed pens, quill pens, and dip pens were used, with a nib of some sort to be dipped in the ink. Ruling pens allow precise adjustment of line width, and still find a few specialized uses, but...
  
   (or similar instrument) in to the bed of the patient's fingernail
  Nail (anatomy)
  A nail is a horn-like envelope covering the dorsal aspect of the terminal phalanges of fingers and toes in humans, most non-human primates, and a few other mammals. Nails are similar to claws, which are found on numerous other animals....
  
  . A fully conscious patient would normally locate the pain and push it away, however a patient who is not alert and who has not responded to voice (hence having the test performed on them) is likely to exhibit only withdrawal from pain, or even involuntary flexion
  Flexion
  In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder...
  
   or extension
  Extension (kinesiology)
  In kinesiology, extension is a movement of a joint that results in increased angle between two bones or body surfaces at a joint. Extension usually results in straightening of the bones or body surfaces involved. For example, extension is produced by extending the flexed elbow. Straightening of...
  
   of the limb
  Limb (anatomy)
  A limb is a jointed, or prehensile , appendage of the human or other animal body....
  
  s from the pain stimulus. The person assessing should always exercise care when performing pain stimulus as a method of assessing levels of consciousness, as in some jurisdictions, it can be considered assault. This is a key reason why voice checks should always be performed first, and the person assessing should be suitably trained.
• Unresponsive - Sometimes seen noted as 'Unconscious
  Unconsciousness
  Unconsciousness is the condition of being not conscious—in a mental state that involves complete or near-complete lack of responsiveness to people and other environmental stimuli. Being in a comatose state or coma is a type of unconsciousness. Fainting due to a drop in blood pressure and a...
  
  ', this outcome is recorded if the patient does not give any Eye, Voice or Motor response to voice or pain.

In first aid

First aid

First aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care...

, 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.

In some emergency medical services

Emergency medical services

Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...

 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 he/she could correctly identify the time, their name, their location, and the event.

Ambulance crews may begin with an AVPU assessment, to be followed by a GCS assessment if the AVPU score is below "A."

The AVPU scale is not suitable for long-term neurological observation of the patient; in this situation, the Glasgow coma scale

Glasgow Coma Scale

Glasgow Coma Scale or GCS is a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment...

is more appropriate.