Alert, voice, pain, unresponsiveness

The patient s level of consciousness should be assessed continually using the alert, voice, pain, unresponsiveness (AVPU) or GCS systems. If seizures develop, despite adequate oxygenation and blood glucose, then treat the seizures immediately with intravenous (IV) diazepam or lorazepam. 

In the pre-hospital environment, AVPU (alert, voice, pain, unresponsive) and a brief assessment of the pupils is sufficient. 

Disability should be assessed using the simple AVPU scale (Alert, responds to Voice, responds to Pain, Unresponsive). This assessment should be repeated at frequent intervals to assess the progress of the casualty. 

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