Confusion physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Physical examination

  • Vital signs
    • Temperature : increase in temperature is significant for some infective foci.
    • Blood pressure : if decreased indicative of shock and hypoperfusion.
    • Pulse : if its increase it has to be correlated to raise in temperature.
    • Respiratory rate : there may be hyperventilation in few conditions due to anxiety, but in severe cases leading to coma respiratory rate may be compromised.
  • General examination : A comprehensive examination may be tough due to altered mental status of the patient.
    • General behavior
    • Level of arousal
    • Alertness
    • Language or speech defects
    • Presence of agitation, restlessness, hyperactivity, anxiety
  • Focused examination of Nervous system
    • Cranial nerve examination : this is limited by uncooperative patients. Funduscopic examination helps in checking for papilledema or hemorrhages. Checking for gag reflex to ensure safe oral feeds and medications.
    • Motor examination : underlying brain disease
    • Gait evaluation : check for cerebellar lesion
  • Other signs suggesting underlying causes
    • Skull fracture - trauma
    • Neck stiffness - meningitits
    • Lip erosions - ingestion of poisons
    • Indwelling catheters - sepsis
    • Tongue bites - seizures
    • Neck swelling - thyroid disease
    • Signs of liver failure
    • Excessive sweating - dehydration, hypoglycemia

References

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