AVPU/ Glasgow Coma Scale

Introduction to GCS and AFPU

• The video discusses the Glasgow Coma Scale (GCS) and the AFPU score, focusing on the AFPU first as a simpler assessment.

AFPU Scale

• Mnemonic: AFPU

  • A for Alert:

    • Patient is awake and oriented.

    • "Oriented times four" indicates awareness of self, place, time, and event.

  • V for Verbal:

    • Patient responds to verbal stimuli.

    • Example: Responds when asked a question.

  • P for Painful stimuli:

    • Patient responds to painful stimuli (e.g., sternal rub).

  • U for Unresponsive:

    • Patient shows no response to verbal or painful stimuli.

Understanding GCS (Glasgow Coma Scale)

• The GCS is a more detailed score used in emergency medicine with a maximum score of 15 and a minimum score of 3.

• Mnemonic: EVM456

  • Represents the three sections of the GCS score: Eye opening (E), Verbal response (V), and Motor response (M).

Eye Opening (E)

• Scoring: 4 (normal), 3, 2, 1 (no response).

  • 4: Opens eyes spontaneously.

  • 3: Opens eyes in response to speech.

  • 2: Opens eyes in response to pain.

  • 1: No eye opening.

Verbal Response (V)

• Scoring: 5 (oriented), 4 (confused), 3 (inappropriate words), 2 (incomprehensible sounds), 1 (no response).

  • 5: Oriented times four.

  • 4: Confused but verbal.

  • 3: Random words; speech doesn't make sense.

  • 2: Speech is incomprehensible; mumbling.

  • 1: No verbal response.

Motor Response (M)

• Scoring: 6 (obeys commands), 5 (localizes pain), 4 (withdraws from pain), 3 (flexion posturing), 2 (extension posturing), 1 (no response).

  • 6: Follows commands (e.g., lifts arm).

  • 5: Localizes pain (grabbing an injured arm).

  • 4: Withdraws from painful stimuli (pulling away).

  • 3: Decorticate posturing (flexed arms to torso).

  • 2: Decerebrate posturing (extended arms).

  • 1: No motor response.

Scoring Summary

• Total GCS Score: Sum of eye, verbal, and motor responses.

  • Example: E=4, V=4, M=3 --> Total = 11.

• Interpretation:

  • 15: Normal responsiveness.

  • 3: Comatose.

  • Scores below 8 indicate severe illness; scores above 8 may suggest caution but not extreme illness.

• Most patients present between 13-15, while GCS below 8 requires close monitoring.