A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination-including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin, mucous membranes, and sclerae (white part of the eye) [cyanosis (bluish discoloration of the skin/mucous membranes in the absence of oxygen)?; generalized edema (water retention in the tissues)?; petechiae (“flea-like bleeding”) in coagulation disorders?]
- Determination of capillary refill time (CRT) to assess microcirculation and circulatory situation; CRT = time required for capillary bed to refill after external application of pressure (3-5 sec); measurement on finger or sternum under optimal light conditions; normal CRT:
- In neonates: – 3 sec.
- For children 2-3 sec.
- Notice: In the guideline on sepsis in children, a RKZ > 2 sec on the body trunk is given as a criterion for SIRS with organ complication
- Determination of capillary refill time (CRT) to assess microcirculation and circulatory situation; CRT = time required for capillary bed to refill after external application of pressure (3-5 sec); measurement on finger or sternum under optimal light conditions; normal CRT:
- 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) [cyanosis (bluish discoloration of the skin/mucous membranes in the absence of oxygen)?; generalized edema (water retention in the tissues)?; petechiae (“flea-like bleeding”) in coagulation disorders?]
- Auscultation (listening) of the heart.
- Auscultation of the lungs
- Palpation (palpation) of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
- Inspection (viewing).
- Assessment of consciousness using the Glasgow Coma Scale (GCS).
- Assessment of organ function using the SOFA score (for: “Sequential (Sepsis-Related) Organ Failure Assessment Score”) [see below Sepsis/Classification].
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.