Chapter 3. An introduction to clinical examination

Examination will be described in the order used in the standard approach which is a common theme throughout this book – the <C>ABCDE system.

No examination is performed without clues from the history and attention should be paid to other information such as mechanism of injury, patterns of vehicle damage and damage to protective clothing or helmets.

Often an assessment of A–D is made by a simple question: ‘Are you OK?’ If this elicits a response such as ‘Yes, but my ankle hurts’, this means the airway is clear, the patient is breathing enough to speak clearly, the brain is adequately perfused and the Glasgow Coma Score is either 14 or 15.

<C> is applied in cases of catastrophic haemorrhage where control of bleeding takes priority over the rest of the primary survey.

Airway

Possible abnormal noises originating in the upper airway include the following:

Gurgling

Gurgling suggests the presence of fluid in the airway, possibly blood, saliva or stomach contents that have been regurgitated. This will require suction.

Snoring

This is usually caused by the soft tissues of the nasopharynx and oropharynx flopping back against the posterior wall of the throat, partially obstructing the flow of air.

Stridor

Stridor is caused by partial blockage of the upper airway by swelling (due to burns, infection or anaphylaxis) or a foreign body.

Hoarseness

Hoarseness has many causes, all relating to pathology around the larynx and vocal cords.

A more formal visual inspection is then carried out to assess for swelling, the presence of a foreign body, trauma or bleeding that may compromise the airway. An assessment of the airway goes hand in hand with an assessment of breathing and if there is no evidence of breathing, airway opening manoeuvres should be performed to ascertain if there is respiratory effort.

Other features which should be sought when examining the neck are summarised in Box 3.1.

Box 3.1

Findings on neck examination

• Distended neck veins.