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 temperature, body weight, body height, body temperature; furthermore:
- Inspection (viewing)
- Skin, mucous membranes, and sclerae (white part of the eye) [sweating (hot, very red skin, glassy eyes in high fever); exanthema (rash)?]
- Foreign body search
- Orienting tooth status
- Knocking pain paranasal sinuses?
- Inspection and palpation (palpation) of the lymph node stations.
- Palpation (palpation) of prominent bone points, tendons, ligaments; musculature; joint (joint effusion); soft tissue swelling; pressure pain (localization!).
- Auscultation (listening) of the heart.
- Examination of the lungs
- Auscultation of the lungs
- Bronchophony (checking the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the physician listens to the lungs)[increased sound transmission due to pulmonary infiltration/compaction of lung tissue (e. e.g. in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in case of decreased sound conduction (attenuated or absent: e.g. in pleural effusion, pneumothorax, emphysema). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
- Vocal fremitus (checking the conduction of low frequencies; the patient is asked to pronounce the word “99” several times in a low voice while the physician places his hands on the patient’s chest or back)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g. e.g. in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in case of reduced sound conduction (attenuated: e.g. atelectasis, pleural rind; strongly attenuated or absent: in case of pleural effusion, pneumothorax, pulmonary emphysema). The result is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
- Palpation (palpation) of the abdomen (abdomen) including examination of the renal bearings (pressure pain?, knocking pain?, coughing pain?, defensive tension?, hernial gates?, renal bearing knocking pain?)
- Neurological examination – including testing of pupils, reflexes.
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.
Square brackets [ ] indicate possible pathological (pathological) physical findings.
