Poisonings (Intoxications): Examination

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 [puncture marks?, central cyanosis (bluish discoloration of skin and central mucous membranes, e.g., tongue)]
      • Respiratory tract [vomit?, substance residue?, salivation?, dry mucous membranes?, burns?]
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture? [Injuries?]
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
      • Urogenital region
    • Breath odor [foetor ex ore/mouth odor].
    • Auscultation (listening) of the heart
    • Auscultation of the lungs
    • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
    • Surgical examination [trauma?]
    • Neurological examination

Square brackets [ ] indicate possible pathological (pathological) physical findings.

Glasgow Coma Scale (GCS) – scale for the estimation of 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.