Examination of Patients in the Intensive Care Unit

• Careful examination of the intensive care unit (ICU) patient remains essential because it is the only way (among many examples) to detect the purulence around intravenous lines, the warmth of an infected joint, the purpuric skin lesions of septic emboli, the wheezing of bronchospasm, the neck stiffness of meningitis, or the absent doll’s-eyes of cerebellar stroke. • The modified early warning score accurately identifies a patient’s risk of hospital mortality. • In patients with shock, several findings have diagnostic value. For example, the absence of warm hands decreases the probability of septic shock, the presence of elevated venous pressure and crackles increases the probability of cardiogenic shock, and the presence of a pulse pressure increment after passive leg elevation increases the probability of hypovolemic shock. • The findings of cool limbs, prolonged capillary refill times, and mottling of the limbs (i.e., blotchy or lacelike pattern of dusky discoloration) all increase the probability of reduced cardiac output and a worse prognosis.