A comprehensive clinical examination is the basis for selecting further diagnostic steps.
The patient is assessed using the Glasgow Coma Scale. This contains the following criteria:
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, a very severe brain dysfunction is assumed and the there is a risk of life-threatening respiratory disorders.
- With a GCS ≤ 8, airway protection must be considered.
This is followed by a comprehensive physical and neurologic examination:
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection
- Skin and mucous membranes [injuries?, bruise marks?, signs of intoxication?]
- In the current presence of epilepsy [distinction between seizure? and flexion/extension synergisms in entrapment?]
- Auscultation of the heart
- Auscultation of the lungs
- Palpation of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?)
- Inspection
- Neurological examination – including.
- Examination of pupillary response, reflex testing, etc.
- Examination for meningismus [meningismus? (esp. note in presence of febrile infection)]]
- If postically responsive patient [persistent focal neurologic deficit?]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.