A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- Assessment of consciousness using the Glasgow Coma Scale (GCS).
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (viewing).
- Skin and mucous membranes
- Neck vein congestion?
- Central cyanosis? (bluish discoloration of skin and central mucous membranes, e.g., tongue).
- Abdomen (abdomen):
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Extremities (palpation (feeling) of peripheral pulses, looking for edema/water retention).
- Auscultation (listening) of the heart and central arteries (flow sounds?).
- Auscultation of the lungs
- Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
- Inspection (viewing).
- Neurological examination – assessment of patient’s level of consciousness; functional deficits (severity)?
- Ataxia (gait disturbances)?
- Epileptic seizures?
- Cranial nerve involvement with corresponding symptoms, e.g.:
- Dysphagia
- Deviation of the tongue when sticking it out
- Gaze deviation (involuntary and non-influential movement of both eyes in the same direction).
- Gaze paralysis
- Spontaneous nystagmus (uncontrollable and rhythmic movements of the eye; they already occur without external stimuli).
- Paresis (paralysis)
- Checking the sensitivity and motor function
- Testing reflexes (especially the biceps tendon reflex (BSR), triceps tendon reflex (TSR), radius periosteal reflex (RPR), patellar tendon reflex (PSR) and the Achilles tendon reflex (ASR, also triceps surae reflex), Babinski reflex (the pressureful brushing of the lateral edge of the foot leads to an upward extension of the big toe)).
Square brackets [ ] indicate possible pathological (pathological) physical findings.
FAST test
With the help of the so-called FAST test, typical apoplexy symptoms can be checked – even for medical laypersons:
- F = Face (face paralyzed on one side? ); Test: ask the patient to smile.
- A = Arms (arm movement restricted? ; Test: ask patient to raise both arms simultaneously, turning palms upward.
- S = Speech (speech slurred? ); Have the patient repeat a simpler sentence.
- T = Time (Do not waste time! Tel. 112).
The FAST test has a sensitivity (percentage of ill patients in whom the disease is detected by the application of the history, i.e. a positive result occurs) of 64-97% and a specificity (probability that actually healthy people who do not suffer from the disease in question are also detected as healthy by the procedure) of 13-63%. Glasgow Coma Scale (GCS) – scale for estimating a disorder of consciousness.
| Criterion | Score | |
| Eye opening | spontaneous | 4 |
| on request | 3 | |
| on pain stimulus | 2 | |
| no reaction | 1 | |
| Verbal communication | conversational, oriented | 5 |
| conversational, disoriented (confused) | 4 | |
| incoherent words | 3 | |
| unintelligible sounds | 2 | |
| no verbal reaction | 1 | |
| Motor response | Follows prompts | 6 |
| Targeted pain defense | 5 | |
| untargeted pain defense | 4 | |
| on pain stimulus flexion synergisms | 3 | |
| on pain stimulus stretching synergisms | 2 | |
| No response to pain stimulus | 1 |
Assessment
- Points are awarded for each category separately and then added together. The maximum score is 15, the minimum 3 points.
- If the score is 8 or less, very severe brain dysfunction must be assumed and the is a risk of life-threatening respiratory disorders.
- With a GCS ≤ 8, securing the airway by endotracheal intubation (insertion of a tube (hollow probe) through the mouth or nose between the vocal folds of the larynx into the trachea) must be considered.
