Clinical Examination of the Critically Ill

Reviewed and revised 1 September 2015

OVERVIEW

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)

Lifeinthefastlane.com