Start with the head and face.
- Examine the head for lacerations, abrasions, foreign bodies, bony malformations, and unstable midface bones.
- Examine the ears for hemotympanum, tympanic membrane rupture, blood or csf within the canal, external trauma and Battle's sign.
- Examine the eyes for papilledema, globe rupture, unequal pupils, abrasion, and foreign body intrusion.
- Inspect the nose for bleeding, septal hematoma, CSF leakage.
- Inspect the mouth for dental injury, bleeding and posterior oropharynx obstruction, swelling, or edema.
- Perform a neurologic exam testing the cranial nerves
Examine the Neck and Chest
- Palpate the neck for bony injury, crepitus, and midline trachea, lacerations, hematomas, and abrasions.
- Examine the patient's work of breathing by looking at the respiratory rate, accessory muscle use, or inspiratory retractions.
- Inspect and palpate the chest, looking for obvious deformity, areas of ecchymosis, penetrating wounds, crepitus, and flail chest or other indicators of underlying lung injury that may cause difficulty breathing or pneumothorax.
- Auscultate lung sounds in all fields.
Abdomen, Back and Pelvis
- Inspect the abdomen by looking for distention, tenderness to palpation, penetrating injury, abrasions, seatbelt sign, and/or bruising.
- It is important to log roll the patient to evaluate the patients back and flank while maintaining spine precautions. Look for penetrating injuries, palpate for step offs along the spine, evaluate for bruising and bony tenderness. Bruising along the patient's bilateral flanks or surrounding the patient's umbilicus may represent a retroperitoneal hemorrhage.
- Palpate the pelvis for stability.
- Evaluate the patient's rectum as well as a genitourinary exam. A digital rectal exam may be performed when fully assessing the patient's disability (neurologic function). Evaluate for the presence of blood or perineal injury.
- Evaluate the patient's genitals looking for any bleeding, ecchymosis, or lacerations.
Extremities - The musculoskeletal exam follows and includes a thorough examination of all four extremities.
- Palpate extremities to assess for pain, decreased temperature, or tension that may indicate compartment syndrome.
- Evaluate the color of extremities looking for pallor or delayed capillary refill that indicates possible blood loss, and cyanosis that may indicate decreased oxygen perfusion.
- Look for bruising, laceration, abrasion, open fractures, bony abnormalities, and active bleeding.
- Perform a full neurologic exam strength, sensation, coordination, and reflexes.
