Question

Jef with Acute Hypoxemic Respiratory failure. He is 45-year-old presented to the emergency department with a 10-day history of slight fever followed by rapidly progressive dyspnea for 3 days prior to admission. He indicated to the at-tending physician that he had always kept himself in good health and "very fit." He did admit to a loss of his usually good appetite and was unable to work for the past few days due to shortness of breath, overall weakness, and a slight sore throat_ A nonsmoker, he denied the use of alcohol and had no prior history of any medical illness other than borderline high blood pressure. He is 6 feet 2 Inches and weighs 195 lb.

On observation: The patient appeared to be in moderate-to-severe respiratory distress with mild central cyanosis. Vital signs showed a temperature of 101.0°F, resting respiratory rate of 30 breaths/ minute, and blood pressure of 100/65, Breath sounds revealed extensive fine Inspiratory crackles, Physical examination of the heart revealed a resting tachycardia of 120 beats/minute. The patient was immediately given supplemental oxygen via a nasal cannula at 4 L/ minute, and pulse oximetry revealed a saturation of 86%. An arterial blood as (ABC) test while receiving oxygen at 4 L/minute showed a pH of 7.48, Paco2 23 tom Pao2 48 torr, HCO-3 20 mEq/L, and Sao2 85%. A complete blood count (CBC) drawn in the emergency department revealed a hemoglobin level of 14.4 g/L. The patient had a white blood cell count of 30,000/mm³ with 84% neutrophils, 9% lymphocytes, 5% monocytes, and 2% eosinophils. A portable chest x-ray taken in the emergency department revealed diffuse bilateral alveolar infiltrates with normal cardiac size. After the ABC test, the patient received a non-rebreather mask at 12 L/minute and broad-spectrum intravenous antibiotics (erythromycin and levofloxacin). Because no significant improvement was noted clinically or with ABC measurements over the next 12 hours, the patient was transferred to the intensive care unit (ICU), with the anticipation of the need for mechanical ventilation. In the ICU, the patient was placed on continuous positive airway pressure (CPAP) with an initial setting of 5 cm H2O and an Fio2 of 60%. Within 1 hour of starting CPAP, there was a drastic improvement in the respiratory rate (falling from 30 to 18 breaths/minute) in addition to a significant improvement in ABCs. There were additional CPAP adjustments, with maximum CPAP of 8 cm I-120 administered during his hospital stay. Gradually, clinicians brought the level of CPAP down over several hours, as the patient's clinical condition and ABCs showed progressive improvement. He was discharged after a 12 day hospital stay, achieving a satisfactory ABG result on room air and advised to continue erythromycin for an additional period of 3 weeks. On 1-month follow-up, the patient was asymptomatic, with complete clearing of the previously noted infiltrate on standard chest x-ray.

what his AVPU score?

Answer 1

AVPU scale is a simple tool to assess the level of consciousness of a patient. It is highly useful for EMS crew and first aiders.

‘AVPU’ is a mnemonic consisting four possible outcomes or scores as outlined below

Mnemonic	Meaning	Score
A	Alert = the patient will respond spontaneously to the examiner and environment	A
V	Verbal = the patient will not respond spontaneously, but can respond to verbal stimulus	V
P	Pain = the patient will respond only to the painful stimuli,	P
U	Unresponsive= the patient will have no spontaneous, motor or verbal response.	U

In the above given scenario, the patient’s AVPU score is ‘A’ because he is alert and able to give spontaneous response to the EMS crew when he arrived in the emergency department.