Physical Exam Key Points

1. Vital signs. Tachycardia, hypotension, hypoxemia, and fever are suggestive of substantial bleeding or sepsis, or both.

2. Mouth. Check that tube is not kinked in the mouth or throat. Look for evidence of oral, nasal, or pharyngeal bleeding.

3. Abdomen. Look for distention, tenderness, and peritoneal signs. Listen for bowel sounds. Absence of bowel sounds indicates obstruction. Distention occurs with ileus or obstruction.

4. Rectal exam. Is stool present? Absence of stool may reflect an anatomic obstruction. Check stool for occult blood. Assess color and character of stool (normal versus melena versus fresh blood).

5. Tube. Check patency and function by flushing with air or water. Check gastric fluid pH if tube is patent; pH < 4 promotes bleeding.

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