List Archives

Wed, 20 Feb 2002 22:11:16 +0200 (IST)

AVPU was part of the original ATLS protocol. Stayed there until 1997, when
it was replaced by the more robust GCS.=20

The idea behind it was a simple qualitative measure of Neuro status. It
was analogous to getting a qualitative measure of the pulse, without
actually measuring it.  The authors probably felt that AVPU to GCS was
like qualitative pulse (fast, normal, slow, weak, strong)  to actual HR
and BP. =20

Like many things in the ATLS, it was never validated.=20

If you do the rapid (<15 sec) primary survey properly, you get
enough information to calculate GCS. I suspect that once they realized
this, AVPU was discarded.=20

Interestingly, the rapid primary survey is not well described in the ATLS
manual. A much better description is in the PHTLS manual.=20

The suggested sequence for the patient management scenarios (which are
used for the final examination in the ATLS) all state that the first step
is a rapid assessment of the ABCDE. Followed by treatment of the airway
etc. But the slides of the second lecture obscure this most important
first step.=20
=20

Avi=20

=20

On Wed, 20 Feb 2002, Bjorn, Pret wrote:

> Karim,
> =20
> I agree with your sentiments.  But they don't answer my question.
> =20
> Where did AVPU come from?
> =20
> I'm interested because I too think it's a sloppy, unscientific, meaningle=
ss
> method of assessment.  Nonetheless, it's taught as a primary survey
> component in PHTLS, TNCC, and ATLS. =20
> =20
> I'm alarmed at this consensus endorsement of a behavior which has little =
if
> any scientific basis, and I spend a good deal of otherwise perfectly usef=
ul
> time UN-teaching it to my friends and colleagues who actually work among
> acutely injured patients.  Rather than simply spray around my opinion,
> however, I'd like to assemble a small fund of knowledge on the topic.  Su=
ch
> would include AVPU's history and origins.  I'm finding them elusive.
> Probably says much about the subject.
> =20
> Thanks anyhow.
> =20
> Pret
>=20
> -----Original Message-----
> From: Karim Brohi [mailto:karim@trauma.org]
> Sent: Tuesday, February 19, 2002 6:33 PM
> To: trauma-list@trauma.org
> Subject: RE: AVPU trivia
>=20
>=20
> I thought AVPU had died and gone to heaven. =20
> It was murdered in its sleep by the more robust and powerful Glasgow Coma
> Scale.
> =20
> AVPU is essentially a bastardised GCS - and the weakest components of it.
> If you wanted to trim the GCS (and why would you - it only takes 5 second=
s)
> you'd limit it to Best Motor Response (in the upper limb)
> =20
> AVPU is dead and gone.  Let it rest in peace.
> =20
> Karim
> =20
> PS.  The Glasgow Coma Scale is so powerful it's even, apparently, used in
> Edinburgh
> =20
> =20
>=20
> -----Original Message-----
> From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]O=
n
> Behalf Of Rosann Juska
> Sent: 19 February 2002 07:27
> To: trauma-list@trauma.org
> Subject: Re: AVPU trivia
>=20
>=20
> A-Alert
> V-responds to Verbal
> P- responds to Pain
> U-unresponsive
> =B8..=B7 =B4=A8=A8))  -:=A6:-
>      =B8.=B7=B4 .=B7=B4=A8=A8))
>    ((=B8=B8.=B7=B4  ..=B7=B4   -:=A6:-=20
>   -:=A6:-    ((=B8=B8.=B7=B4*    =20
>                    Rosann Juska
>=20
>=20
> ----- Original Message -----=20
> From: Bjorn, Pret <mailto:pbjorn@emh.org> =20
> To: Trauma-List (E-mail) <mailto:trauma-list@trauma.org> =20
> Sent: Monday, February 18, 2002 1:02 PM
> Subject: AVPU trivia
>=20
> An oxymoron, I know...
> =20
> But does anyone know the origins of the AVPU mnemonic?  Who originally
> recommended it?  And where might I find even one evidence-based endorseme=
nt?
> I've been looking all day, suspect I know the answers, but I always test =
my
> assumptions against the wisdom of the List.
> =20
> Thanks in Advance.
> =20
>=20
> Pret Bjorn
> Trauma Coordinator
> EMMC Trauma Program
> 489 State Street
> Bangor, ME 04401
> =20
> 207.973.7260 (office)
> 207.973.7673 (fax)
> 207.941.5085 (voice pager)
> =20
>=20
>=20

=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=
=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=
=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D
Aviel Roy-Shapira, M.D.              Soroka University Hospital &
Dept. of Surgery A. and              Ben-Gurion University Medical School=
=20
the Critical Care Unit               POB 151, Beer Sheva, Israel
=20
email:avir@bgumail.bgu.ac.il         Fax:972-7-6403260 voice:972-7-6403390

List Archives

For your convenience, find the Trauma List Archive Below

AVPU trivia