Toxicologic Physical Examination

The comprehensive physical examination must be performed on a fully undressed patient. This affords the physician every opportunity to check the patient's clothing for substances still retained in the pockets or substances hidden on the patient's body (waistbands, groin, or between skinfolds). In addition, physicians must pay special attention to certain aspects of the physical examination. Care must be taken when searching belongings, particularly pockets, because health care providers have been stuck by uncapped needles.

The skin must be examined for cyanosis or flushing, excessive diaphoresis or dryness, signs of injury or injection, ulcers, or bullae. Bruising may be a clue as to duration of unconsciousness, as well as coagulopathy. Examine the eyes for pupil size, reactivity, nystagmus, dysconjugate gaze, or excessive lacrimation. Hypersalivation or excessive dryness should be noted in the oropharynx. The chest examination should include careful evaluation of the lungs to assess for bronchorrhea, or wheezing, and the heart must be assessed for its rhythm, rate, and regularity. Bowel sounds, urinary retention, and abdominal tenderness or rigidity must also be noted. The extremities must be evaluated for tremor or fasciculation. Cranial nerves, reflexes, resting muscle tone, coordination, cognition, and the ability to ambulate all must be assessed.

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