[The clinical examination of the critically ill patient in the intensive care unit].
Various circumstances hinder the clinical examination of a patient in an intensive care unit (ICU). Nevertheless, the clinical assessment is crucial for the formulation of a diagnostic and therapeutic plan. History and clinical examination need to be performed timely and efficiently. They are best done in a structured manner, so that no important details are missed. The doctor should follow the concept of "A B C", in which "A" stands for airways, "B" for breathing and "C" for circulation. It is essential that some pathological findings in the clinical examination prompt immediate therapeutic interventions to avoid further deterioration. Thorough clinical assessment is normally performed at the time of patient's admission to the ICU. However, parts of history and clinical examinations may still be missed. It is therefore crucial that this information is obtained as soon as possible as it may help with the management of the patient. Clinical examination is repeated at the daily ward rounds as well as at any time that the patient's condition changes. Results of tests and data collected from monitoring equipment should be viewed as an addition to the patient's clinical assessment and must not distract the clinician from the patient's clinical condition. Precise documentation of the findings is vital to allow comparison of the patient's progress on a daily basis and to provide continuity of care.
Rudiger
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Bloomsbury Institute of Intensive Care Medicine and Wolfson Institute of Biomedical Research, University College London. a.rudiger@ucl.ac.uk
D002983:Clinical Competence; D003422:Critical Care / Q000379:methods* / Q000639:trends; D016638:Critical Illness; D003661:Decision Support Techniques; D003695:Delivery of Health Care / Q000379:methods* / Q000639:trends; D005858:Germany; D006801:Humans; D008487:Medical History Taking / Q000379:methods*; D010808:Physical Examination / Q000379:methods* / Q000639:trends; D010819:Physician's Role