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Do you examine your ICU patients?

Discussion in 'Critical Care' started by kimbosliced, Apr 11, 2018.

  1. kimbosliced

    7+ Year Member

    Jan 12, 2010
    Likes Received:
    Resident [Any Field]
    Do you guys physically examine your ICU patients daily?

    If so, what type of physical exam do you actually do?

    I’m asking because I have attendings that maybe just enter the room to do vent changes and some do a full cardiologist physical exam head to toe and rolling the patient daily and some don’t enter the room at all.

    In forming my own practice as a fellow, I typically examine my patients but certainly not as thoroughly as I did as a resident.

    Should we as physicians be examining our ICU patients head to toe daily on rounds, should it be focused?

    Just curious.
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  3. jdh71

    jdh71 epiphany at nine thousand six hundred feet
    Physician 10+ Year Member

    Dec 14, 2006
    Likes Received:
    Attending Physician
    Yeah. I hit the major "stethoscope organs". Check for edema. See if they are responsive and will follow commands. Minimal neuro exam: pupils (and sometimes pain response).

    Otherwise it's on a patient to patient basis if I do more.

    Just don't ever ever ever document an exam you didn't do.

    You don't need the exam to bill CCT
    #2 jdh71, Apr 11, 2018
    Last edited: Apr 11, 2018
    pencilcase and WheezyBaby like this.
  4. SurfingDoctor

    SurfingDoctor "Hooray, I'm useful"
    Physician Faculty 10+ Year Member

    Oct 20, 2005
    Likes Received:
    Attending Physician
    Neuro: Pupils, response to stim (and how much), or if they are awake, strength and tone left versus right. Gag and cough presence if I know they have neuro injury
    CV: Sounds, pulses, cap refill
    Resp: Retractions or if intubated, work of breathing, sounds
    Abd: Level of firmness, level of distention, pain
    Ext: Pulses, edema (though best place is chest wall or sacral)
    Skin: incisions, ostomy sites

    That's the general, unless the patient has something specific that needs more. I do it not for billing, but more for CYA and the occasional random pickup (ie the 15 year who had a stroke with a negative ECHO 1 week ago, but now has a diastolic murmur)
    WheezyBaby likes this.
  5. bigdan

    bigdan SDN Donor
    15+ Year Member

    Dec 30, 2002
    Likes Received:
    Attending Physician
    I do, and to a similar extent to those reported above.
    Tend to focus more on areas of concern (e.g.: more in-depth neuro exam if stroke/concern for stroke)

    Would hope someone would do the same for me if I ever end up on the receiving end of treatment

    I think there is more "cred" established when RNs/RTs/family/patients see that attention is being paid.

    EMT2ER-DOC Why so Serious?????
    Physician 10+ Year Member

    Oct 16, 2003
    Likes Received:
    Attending Physician
    Each and every one. Even when I have house staff, before I sign anyone’s notes I examine the patient and speak to them (if they are not sedated). Not only is it good practice but if things go south, you don’t need to rely on someone else’s initial PE.
    FFP likes this.

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