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The Paediatric Consultation
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Using the acronym AVPU is a quick way of assessing the consciousness level in a child and to signal progressively decreasing consciousness level and need for intubation: AlertResponds to VoiceResponds to PainUnresponsive
Maternal Cardiorespiratory Arrest
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Nilmini Wijesuriya
Proper management of Airway, Breathing, Circulation, Disability and Exposure (ABCDE), is important as in any other patient in order to maximise the chances of survival when managing CRA in pregnancy. An AVPU (alert, verbal stimulus, pain stimulus and unresponsive) assessment, should be performed, because an altered state of consciousness can be a sign of critical illness. The basic principles of resuscitation in a pregnant woman are more or less similar to those in a non-pregnant woman. However, the physiological and anatomical changes that occur during pregnancy should be taken into consideration (Table 7.2), and resuscitation must be modified accordingly.
Polytrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
In view of the time constraints, AVPU is the simple mnemonic used to describe the level of consciousness of the patients as alert (A), responds to verbal stimuli (V), responds to pain (P), or unresponsive (U). GCS is used in the secondary survey for detailed assessment of the conscious level.
Performance of prediction models for short-term outcome in COVID-19 patients in the emergency department: a retrospective study
Published in Annals of Medicine, 2021
Paul M. E. L. van Dam, Noortje Zelis, Sander M. J. van Kuijk, Aimée E. M. J. H. Linkens, Renée A. G. Brüggemann, Bart Spaetgens, Iwan C. C. van der Horst, Patricia M. Stassen
Data collection was performed by medical students and resident doctors, who were blinded to the study hypotheses. We collected data on age, sex and information regarding comorbidity according to the Charlson Comorbidity Index (CCI) from electronic medical records [22]. We also retrieved the following vital signs: heart rate (HR), systolic blood pressure (SBP), mean arterial blood pressure (MAP), respiratory rate (RR), oxygen saturation, temperature and Glasgow Coma Scale (GCS). For each vital sign, we used the initial (i.e. first recorded) value during the ED visit. The Alert Verbal Pain Unresponsive (AVPU) scale was derived from the GCS [23]. If RR or GCS were missing, we used paCO2 and descriptions in the medical records to deduce these values, similar to other studies [6,18,24]. In addition, we collected routinely assessed laboratory tests: haemoglobin, haematocrit, leukocytes, thrombocytes, lymphocytes, D-dimer, blood gas analysis, bicarbonate, sodium, potassium, blood urea nitrogen (BUN), creatinine, lactate dehydrogenase (LDH), bilirubin, albumin and C-reactive protein (CRP). If haematocrit and pO2 values were missing, we used haemoglobin and oxygen saturation to calculate these values, similar to other studies [25,26].
Intranasal Fentanyl versus Subcutaneous Fentanyl for Pain Management in Prehospital Patients with Acute Pain: A Retrospective Analysis
Published in Prehospital Emergency Care, 2020
Alain Tanguay, Johann Lebon, Denise Hébert, François Bégin
Eligibility criteria for the pain management protocol include patients who: 1) have a pain score ≥7 on the VNRS; 2) have been offered an analgesic for pain relief by BLS-EMTs; and 3) have accepted the analgesic mean offered. Excluded patients are those: 1) under 14 years of age (23); 2) categorized as “P” or “U” on the “alert, verbal, pain, unresponsive” (AVPU) consciousness scale (24); 3) known to be allergic to fentanyl; or 4) have one of the following clinical criteria: a systolic blood pressure (SBP) <90 mmHg, a respiratory rate (RR) <12 breaths/min, a pulse rate (PR) <50 pulses/min, or a headache as chief complaint. Being on regular medication or having taken medication (e.g., acetaminophen, anti-inflammatory, etc.) prior to calling EMS are not exclusion criteria.
NEWS and qSIRS superior to qSOFA in the prediction of 30-day mortality in emergency department patients in Hong Kong
Published in Annals of Medicine, 2020
Colin A. Graham, Ling Yan Leung, Ronson Sze Long Lo, Chun Yu Yeung, Suet Yi Chan, Kevin Kei Ching Hung
The primary outcome was 30-day mortality. The secondary outcomes were 7-day mortality and ICU admission. The triage physiological measures were used to calculate qSOFA, SIRS, NEWS, qSIRS, and NSIRS. The 30-day mortality was retrieved from the centralized, computerized medical data system of the hospital, which captures and updates clinical information for all patients in the hospital in real time. The AVPU (Alert, responds to Voice, responds to Pain, Unresponsive) scale was used to identify and characterize altered mentation in the present study, with anything other than ‘Alert’ being taken to indicate altered mentation. Venous blood samples (∼1 ml) were collected by peripheral venepuncture. Lactate measurements were performed using an ED blood gas analyser [RAPIDPoint® 500 Blood Gas Systems (Siemens, US)].