Table 1.

Focused approach to physical diagnosis in the intensive care unit^*

General appearance	Assess the general appearance, nutritional status, comfort level, and clinical “gestalt” of the patient
Head	Inspect the pupils for symmetry and test response to light; look for facial asymmetry. Inspect the nares and oropharynx for bleeding. Inspect the lips, mouth, and tongue for ulceration or lesions. Ensure that the endotracheal tube and enteral tubes are well secured without pressure ulcer or skin damage. Note any loose teeth or caries
Neck	Assess the jugular venous pressure. Inspect any vascular catheter entry sites
Chest	Palpate for subcutaneous air in a ventilated patient. Inspect use of accessory muscles of respiration including diaphragm motion and paradox. With the stethoscope listen for breath sounds bilaterally. Listen for heart sounds, noting second sound splitting, murmurs, rubs, and gallop rhythms
Upper extremities	Assess symmetry of the upper extremities. Inspect all venous and arterial lines. Assess for mottling and peripheral perfusion
Abdomen	Note the pattern of diaphragmatic motion with respiration. Assess for distension and tympany. Palpate for rigidity or involuntary guarding. Assess for liver and spleen enlargement, for masses and for bruits and bowel sounds
Lower extremities	Assess any vascular access sites and palpate pedal pulses. Assess for mottling and peripheral perfusion. Assess for peripheral edema
Neurologic system and mental status	Pupils and facial symmetry were assessed previously. Assess whether the patient can follow commands and whether all four extremities move equally. Assess the plantar response and withdrawal to pain stimuli. Assess delirium using CAM-ICU or other validated metric
Devices and incisions	All surgical sites and device entry sites, including ET tube, vascular access, chest and enteral tubes, and urinary catheters should be assessed. The character and amount of urine in the Foley bag should be noted
Posterior	Examination performed when patient is turned. Pressure ulcers should be inspected. Edema often collects in the rump and lower back due to patient body position
Monitors and waveforms	The ventilator (mode, pressures, minute ventilation, and waveforms), hemodynamic monitor output (venous pressure, arterial pressure tracing), telemetry output, and vital signs, as well as any other bedside monitors, should be inspected for qualitative and quantitative abnormalities
Rest of the room	The presence and mood of the patient’s family members or visitors should be considered

Definition of abbreviations: CAM-ICU = confusion assessment method for the intensive care unit; ET = endotracheal.

^*This examination proceeds by region of the body and takes only minutes for an experienced examiner. Certain components may not be relevant to all ICU patients and ICU populations, and other physical examination maneuvers may be needed in specialty ICUs such as transplant, neurologic, or burn ICUs. The checklist should be modified to suit the clinical circumstances.