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Regarding the remainder of the physical examination, the first task after addressing ABCs is to determine the type and degree of AMS. In general, it is best for the level of consciousness (arousal or alertness) to be described by the response that the patient makes to a given stimulus. EMS clinicians can use the simple mnemonic AVPU to classify their findings.

 A = the patient is Alert

 V = the patient responds only to loud Verbal stimuli

 P = the patient responds only to Painful stimuli

 U = the patient is Unconscious/Unresponsive

EMS clinicians may also use the Glasgow Coma Scale (GCS) (see Chapter 30). A study done with paramedics scoring videotaped patients with AMS confirmed that paramedics can determine GCS scores that correlate well with those of emergency physicians [3]. In addition, a directed and focused physical exam and secondary survey can aid in determining the cause of AMS: