Confusion physical examination

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

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