The entire body should always be examined to rule out concomitant injuries!
A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (viewing).
- Skin (complete undressing to include all wounds) [bruise marks? – e.g., seat belt marks, steering wheel; hematomas?; puncture wounds?, palpation of wound depth; perforating abdominal wound?; shock symptoms, e.g., pallor, cold sweat]
- Abdomen (abdomen):
- Shape of abdomen? [Protrusions?, increasing abdominal girth may be sign of intra-abdominal hemorrhage (internal bleeding)]
- Skin color? Skin texture?
- Efflorescences?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias?
- Gait pattern (fluid, limping).
- Body posture (upright, bent over, gentle posture).
- Examination of the abdomen:
- Auscultation (listening) of the abdomen [bowel sounds?]
- Palpation (palpation) of abdomen [tenderness – left upper abdomen: injury to spleen?; right upper abdomen: injury to liver?; localized guarding?, if present: where?]
- Percussion of the abdomen/examination of the abdomen by tapping the abdominal wall with the fingers [Ballance sign: position-independent attenuation in the left flank as well as below the left diaphragm due to clotted blood filling the splenic lumen].
- Digital rectal examination (DRU) [checking sphincter tone; rectal bleeding]
- Inspection (viewing).
Square brackets [ ] indicate possible pathologic (pathological) physical findings.
