Reviewed and revised 1 September 2015
OVERVIEW
- Pros and cons of clinical examination of the critically ill
ARGUMENTS FOR
- history is often difficult to obtain in the critically ill, clinical signs alone are used to guide treatment and investigation until more definitive information available
- quick and easy to perform
- types of information influence management (especially in an emergency):
- airway: not patent or protected -> intubate, ETT position
- breathing: chest movement, breath sounds (e.g. wheeze)
- circulation: presence of pulses, peripheral and central cyanosis, estimation of peripheral perfusion
- neurological: AVPU, GCS, pupils, localising signs, tone and reflexes, sensation
- skin: lesions, rash, purpura, erythema, papular, spider naevi
- localised tenderness: limb, abdominal quadrant
- abnormal masses: lymph nodes, hepatosplenomegaly
- fundoscopy: subhyaloid haemorrhages, papilloedema
- assessment of invasive devices, dressings, drains…
- important information for neuro-prognostication (e.g. post-cardiac arrest, severe TBI)
ARGUMENTS AGAINST
- lack of sensitivity (missing disease states)
- lack of specificity (wrongly excluding differential diagnoses)
- few high quality studies address the benefits of clinical examination in the critically ill
- general benefits of clinical examination are only supported by lower levels of evidence (including extrapolation from other patient populations)
References and Links
Lifeinthefastlane.com
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