General examination

General examination

Note the patients appearance, condition, and any clues from the environment. This forms the beginning of your mental account of the patient and can be remembered as ACC.

Appearance

Age, race, sex, body habitus (fat/thin). Does the patient display any features which are only present in disease? These features can be remembered with the mnemonic JACCOLT FDM.

  • Jaundice (look for scleral yellowing)

  • Anaemia (look for conjunctival pallor)

  • Cyanosis (look at peripheries and mouth)

  • Lymphadenopathy (cervical, axillary, inguinal etc)

  • Thyroid (is there a goitre?)

  • Fever (is the patient hot and sweaty?)

  • Dehydration (is the patient thirsty, are the mucous membranes moist, is skin turgor reduced, is there a postural drop in blood pressure?)

  • Malnutrition (does the patient look over or under nourished, are the cachectic? Do they have a large body habitus?)

Condition

Do they look alert? Are they comfortable? Are they in pain? Are they tachypnoeic, are there signs of respiratory distress?

Clues

Does the patient have any connections? E.g Cannulae, catheter, central line, oxygen etc. Does the bedside yield any clues? E.g Sputum pot, inhaler, walking stick, mars bars, fruit etc.

Observations

What the patients most recent recorded observations. In particular, what is their:

  • Temperature

  • Blood pressure

  • Pulse

  • Respiratory rate

  • Oxygen saturation

  • Urine output/Drain output/Stoma output etc if these are relevent.

N.B. It may be necessary to break to a DR ABCDE approach if the routine reveals that the patient is acutely unwell.

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