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, mucous membranes, and sclerae (white part of the eye) [Autonomic signs (synonym: adrenergic signs) – these result from reactive adrenaline release. These signs include:
- Paleness
- Ravenous hunger
- Sweating
- Tremor (shaking)]
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Skin, mucous membranes, and sclerae (white part of the eye) [Autonomic signs (synonym: adrenergic signs) – these result from reactive adrenaline release. These signs include:
- Auscultation of the heart [tachycardia? (heartbeat too fast: > 100 beats per minute)]
- Auscultation of the lungs
- Examination of the abdomen
- Auscultation (listening) of the abdomen [vascular or stenotic sounds?, bowel sounds?]
- Percussion (tapping) of the abdomen.
- [Attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?
- Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size]
- Palpation of the abdomen (tenderness?, tapping pain?, coughing pain?, guarding?, hernial orifices?, renal bed tenderness?).
- Inspection (viewing).
- Neurological examination – due toneuroglycopenic signs: These signs result from glucose deficiency in the central nervous system (CNS) (occurrence usually only at blood glucose concentrations < 50 mg/dl). [Glycopenia affects numerous neuronal functions and manifests as follows, among others:
- Atypical behavior (aggressiveness; anxiety).
- Drowsiness
- Paresthesias (non-painful sensation in the area supplied by a cutaneous nerve with signs such as: Tingling, “formication”, furriness, tingling, itching, etc.).
- Speech disorders (aphasia)
- Visual disturbances (blurred vision, double vision).
- Confusion
- Transient hemiplegia (temporary hemiplegia).
- Psychosis or delirium If blood glucose levels continue to fall (< 30-40 mg/dl), severe neurological disorders develop:
- Epilepsy (seizures).
- Unconsciousness
- Coma]
Square brackets [ ] indicate possible pathological (pathological) physical findings.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, a very severe brain dysfunction is assumed and the there 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.