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AVPU trivia
Nick Nudell trauma-list@trauma.orgWed, 20 Feb 2002 15:05:09 -0700
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This is a multi-part message in MIME format. ------=_NextPart_000_0153_01C1BA1F.FCF742E0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Hmmmm.... Used in the primary survey (A,B,C's)? How is it meanningless? Knowing immediately if a patient is responsive (the apparent purpose of = AVPU) is helpful especially for documentation. If a patient is = unresponsive, how can you assess for neuro deficits, tenderness, LOC, or = other vital assessment factors? Perhaps knowing the AVPU score is not going to make a difference for = your treatments, but it may. If someone is U then you may not need RSI = to intubate, for example.... It will definitely affect what assessments = you are able to perform and document. If someone is U then I will not = waste my breath asking "Does this hurt?" and nobody will question why I = did not ask.... I am curious where you are going with this..... and Why you feel it = important to 'UNteach' someone this step? Nick ____ Nick Nudell, NREMT-P Glacier County EMS www.glacierems.com Northern Rockies Medical Center Cut Bank, MT nick@glacierems.com ----- Original Message -----=20 From: Bjorn, Pret=20 To: 'trauma-list@trauma.org'=20 Sent: Wednesday, February 20, 2002 5:35 AM Subject: RE: AVPU trivia Karim, I agree with your sentiments. But they don't answer my question. Where did AVPU come from? I'm interested because I too think it's a sloppy, unscientific, = meaningless method of assessment. Nonetheless, it's taught as a primary = survey component in PHTLS, TNCC, and ATLS. =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 useful 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. Such would include AVPU's history and origins. = I'm finding them elusive. Probably says much about the subject. Thanks anyhow. Pret -----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 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. 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 = seconds) you'd limit it to Best Motor Response (in the upper limb) AVPU is dead and gone. Let it rest in peace. Karim PS. The Glasgow Coma Scale is so powerful it's even, apparently, = used in Edinburgh -----Original Message----- From: trauma-list-admin@trauma.org = [mailto:trauma-list-admin@trauma.org]On Behalf Of Rosann Juska Sent: 19 February 2002 07:27 To: trauma-list@trauma.org Subject: Re: AVPU trivia 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 ----- Original Message -----=20 From: Bjorn, Pret=20 To: Trauma-List (E-mail)=20 Sent: Monday, February 18, 2002 1:02 PM Subject: AVPU trivia An oxymoron, I know... But does anyone know the origins of the AVPU mnemonic? Who = originally recommended it? And where might I find even one = evidence-based endorsement? I've been looking all day, suspect I know = the answers, but I always test my assumptions against the wisdom of the = List. Thanks in Advance. Pret Bjorn Trauma Coordinator EMMC Trauma Program 489 State Street Bangor, ME 04401 207.973.7260 (office) 207.973.7673 (fax) 207.941.5085 (voice pager) ------=_NextPart_000_0153_01C1BA1F.FCF742E0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <HTML><HEAD> <META http-equiv=3DContent-Type content=3D"text/html; = charset=3Diso-8859-1"> <META content=3D"MSHTML 6.00.2600.0" name=3DGENERATOR> <STYLE></STYLE> </HEAD> <BODY bgColor=3D#ffffff> <DIV><FONT face=3DTahoma size=3D2>Hmmmm....</FONT></DIV> <DIV><FONT face=3DTahoma size=3D2></FONT> </DIV> <DIV><FONT face=3DTahoma size=3D2>Used in the primary survey (A,B,C's)? = </FONT><FONT=20 face=3DTahoma size=3D2>How is it meanningless?</FONT></DIV> <DIV><FONT face=3DTahoma size=3D2></FONT> </DIV> <DIV><FONT face=3DTahoma size=3D2>Knowing immediately if a patient is = responsive=20 (the apparent purpose of AVPU) is helpful especially for documentation. = If a=20 patient is unresponsive, how can you assess for neuro deficits, = tenderness, LOC,=20 or other vital assessment factors?</FONT></DIV> <DIV><FONT face=3DTahoma size=3D2></FONT> </DIV> <DIV><FONT face=3DTahoma size=3D2>Perhaps knowing the AVPU score is not = going to=20 make a difference for your treatments, but it may. If someone is U then = you may=20 not need RSI to intubate, for example.... It will definitely affect what = assessments you are able to perform and document. If someone is U then I = will=20 not waste my breath asking "Does this hurt?" and nobody will question = why I did=20 not ask....</FONT></DIV> <DIV><FONT face=3DTahoma size=3D2></FONT> </DIV> <DIV><FONT face=3DTahoma size=3D2>I am curious where you are going with = this.....=20 and Why you feel it <STRONG>important</STRONG> to 'UNteach' someone this = step?</FONT></DIV> <DIV><FONT face=3DTahoma size=3D2></FONT> </DIV> <DIV><FONT face=3DTahoma size=3D2>Nick</FONT></DIV> <DIV> </DIV> <DIV>____<BR>Nick Nudell, NREMT-P<BR>Glacier County EMS<BR><A=20 href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002/3D"http://www.glacierems.com">www.glacierems.com</A><BR>Northern = Rockies=20 Medical Center<BR>Cut Bank, MT<BR><A=20 href=3D"mailto:nick@glacierems.com">nick@glacierems.com</A></DIV> <DIV> </DIV> <DIV><BR> </DIV> <BLOCKQUOTE dir=3Dltr=20 style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; = BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px"> <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV> <DIV=20 style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: = black"><B>From:</B>=20 <A title=3Dpbjorn@emh.org href=3D"mailto:pbjorn@emh.org">Bjorn, = Pret</A> </DIV> <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A = title=3Dtrauma-list@trauma.org=20 href=3D"mailto:'trauma-list@trauma.org'">'trauma-list@trauma.org'</A> = </DIV> <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Wednesday, February 20, = 2002 5:35=20 AM</DIV> <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> RE: AVPU trivia</DIV> <DIV><BR></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D200291812-20022002>Karim,</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D200291812-20022002></SPAN></FONT> </DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN = class=3D200291812-20022002>I=20 agree with your sentiments. But they don't answer my=20 question.</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D200291812-20022002></SPAN></FONT> </DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D200291812-20022002><EM>Where did AVPU come=20 from</EM>?</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D200291812-20022002></SPAN></FONT> </DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN = class=3D200291812-20022002>I'm=20 interested because I too think it's a sloppy, unscientific, = meaningless method=20 of assessment.</SPAN></FONT><FONT face=3DArial color=3D#800000 = size=3D2><SPAN=20 class=3D200291812-20022002> Nonetheless, it's = </SPAN></FONT><FONT=20 face=3DArial color=3D#800000 size=3D2><SPAN = class=3D200291812-20022002>taught as=20 a primary survey component in PHTLS, TNCC, and ATLS. =20 </SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D200291812-20022002></SPAN></FONT> </DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN = class=3D200291812-20022002>I'm=20 alarmed at this consensus endorsement of a behavior which has little = if any=20 scientific basis, and I spend a good deal of otherwise perfectly = useful time=20 UN-teaching it to my friends and colleagues who actually work among = acutely=20 injured patients. Rather than simply spray around my opinion, = however,=20 I'd like to assemble a small fund of knowledge on the topic. = Such would=20 include AVPU's history and origins. I'm finding them = elusive. =20 Probably says much about the subject.</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D200291812-20022002></SPAN></FONT> </DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D200291812-20022002>Thanks anyhow.</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D200291812-20022002></SPAN></FONT> </DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D200291812-20022002>Pret</SPAN></FONT></DIV> <BLOCKQUOTE dir=3Dltr style=3D"MARGIN-RIGHT: 0px"> <DIV class=3DOutlookMessageHeader dir=3Dltr align=3Dleft><FONT = face=3DTahoma=20 size=3D2>-----Original Message-----<BR><B>From:</B> Karim Brohi=20 [mailto:karim@trauma.org]<BR><B>Sent:</B> Tuesday, February 19, 2002 = 6:33=20 PM<BR><B>To:</B> trauma-list@trauma.org<BR><B>Subject:</B> RE: AVPU=20 trivia<BR><BR></DIV></FONT> <DIV><SPAN class=3D067233023-19022002><FONT color=3D#0000ff = size=3D2>I thought=20 AVPU had died and gone to heaven. </FONT></SPAN></DIV> <DIV><SPAN class=3D067233023-19022002><FONT color=3D#0000ff = size=3D2>It was=20 murdered in its sleep by the more robust and powerful Glasgow Coma=20 Scale.</FONT></SPAN></DIV> <DIV><SPAN class=3D067233023-19022002><FONT color=3D#0000ff=20 size=3D2></FONT></SPAN> </DIV> <DIV><SPAN class=3D067233023-19022002><FONT color=3D#0000ff = size=3D2>AVPU is=20 essentially a bastardised GCS - and the weakest components of=20 it.</FONT></SPAN></DIV> <DIV><SPAN class=3D067233023-19022002><FONT color=3D#0000ff = size=3D2>If you wanted=20 to trim the GCS (and why would you - it only takes 5 seconds) you'd = limit it=20 to Best Motor Response (in the upper limb)</FONT></SPAN></DIV> <DIV><SPAN class=3D067233023-19022002><FONT color=3D#0000ff=20 size=3D2></FONT></SPAN> </DIV> <DIV><SPAN class=3D067233023-19022002><FONT color=3D#0000ff = size=3D2>AVPU is dead=20 and gone. Let it rest in peace.</FONT></SPAN></DIV> <DIV><SPAN class=3D067233023-19022002><FONT color=3D#0000ff=20 size=3D2></FONT></SPAN> </DIV> <DIV><SPAN class=3D067233023-19022002><FONT color=3D#0000ff=20 size=3D2>Karim</FONT></SPAN></DIV> <DIV><SPAN class=3D067233023-19022002><FONT color=3D#0000ff=20 size=3D2></FONT></SPAN> </DIV> <DIV><SPAN class=3D067233023-19022002><FONT color=3D#0000ff = size=3D2>PS. The=20 Glasgow Coma Scale is so powerful it's even, apparently, used in=20 Edinburgh</FONT></SPAN></DIV> <DIV><SPAN class=3D067233023-19022002><FONT color=3D#0000ff=20 size=3D2></FONT></SPAN> </DIV> <DIV><SPAN class=3D067233023-19022002></SPAN> </DIV> <BLOCKQUOTE dir=3Dltr style=3D"MARGIN-RIGHT: 0px"> <DIV class=3DOutlookMessageHeader dir=3Dltr align=3Dleft><FONT = face=3DTahoma=20 size=3D2>-----Original Message-----<BR><B>From:</B>=20 trauma-list-admin@trauma.org = [mailto:trauma-list-admin@trauma.org]<B>On=20 Behalf Of </B>Rosann Juska<BR><B>Sent:</B> 19 February 2002=20 07:27<BR><B>To:</B> trauma-list@trauma.org<BR><B>Subject:</B> Re: = AVPU=20 trivia<BR><BR></FONT></DIV> <DIV><FONT face=3D"Goudy Old Style" = color=3D#008080>A-Alert</FONT></DIV> <DIV><FONT face=3D"Goudy Old Style" color=3D#008080>V-responds to=20 Verbal</FONT></DIV> <DIV><FONT face=3D"Goudy Old Style" color=3D#008080>P- responds to = Pain</FONT></DIV> <DIV><FONT face=3D"Goudy Old Style"=20 color=3D#008080>U-unresponsive</FONT></DIV> <DIV>=B8..=B7 =B4=A8=A8)) = -:=A6:-<BR> =B8.=B7=B4=20 .=B7=B4=A8=A8))<BR> ((=B8=B8.=B7=B4 = ..=B7=B4 -:=A6:- <BR> =20 -:=A6:- ((=B8=B8.=B7=B4* = = <BR> &nb= sp; =20 Rosann Juska<BR></DIV> <BLOCKQUOTE=20 style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; = BORDER-LEFT: #008080 2px solid; MARGIN-RIGHT: 0px"> <DIV style=3D"FONT: 10pt arial">----- Original Message ----- = </DIV> <DIV=20 style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: = black"><B>From:</B>=20 <A title=3Dpbjorn@emh.org href=3D"mailto:pbjorn@emh.org">Bjorn, = Pret</A>=20 </DIV> <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A = title=3Dtrauma-list@trauma.org=20 href=3D"mailto:trauma-list@trauma.org">Trauma-List (E-mail)</A> = </DIV> <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Monday, February = 18, 2002=20 1:02 PM</DIV> <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> AVPU = trivia</DIV> <DIV><BR></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D020215720-18022002>An oxymoron, I = know...</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D020215720-18022002></SPAN></FONT> </DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D020215720-18022002>But does anyone know the origins of = the AVPU=20 mnemonic? Who originally recommended it? And where = might I=20 find even one evidence-based endorsement? I've been = looking all=20 day, suspect I know the answers, but I always test my = assumptions=20 against the wisdom of the List.</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D020215720-18022002></SPAN></FONT> </DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D020215720-18022002>Thanks in = Advance.</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D020215720-18022002></SPAN></FONT> </DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D030133519-19052000>Pret Bjorn</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D030133519-19052000>Trauma = Coordinator</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D030133519-19052000>EMMC Trauma = Program</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D030133519-19052000>489 State Street</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D030133519-19052000>Bangor, ME 04401</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D030133519-19052000></SPAN></FONT> </DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D030133519-19052000>207.973.7260 = (office)</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D030133519-19052000>207.973.7673 = (fax)</SPAN></FONT></DIV> <DIV><FONT face=3DArial color=3D#800000 size=3D2><SPAN=20 class=3D030133519-19052000>207.941.5085 (voice=20 pager)</SPAN></FONT></DIV></FONT></DIV> = <DIV> </DIV></BLOCKQUOTE></BLOCKQUOTE></BLOCKQUOTE></BLOCKQUOTE></BO= DY></HTML> ------=_NextPart_000_0153_01C1BA1F.FCF742E0--
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