FINAL PHASE EXAM
The ten steps of the head-to-toe examination are as follows:
Neck. Gently examine for cervical point tenderness (back of neck), deformities at front of neck, and muscle spasms. Ask the patient to move fingers and toes.
Head. Check scalp for cuts, bruises, swellings, or other signs of injury.
Inspect the eyelid and eyes. Determine pupil size (estimate diameter in millimeters), equality, and reactivity to light (shine light quickly in eyes, one at a time and see if the pupils quickly constrict). Look for blood, clear fluids, or bloody fluids in the ears and nose. Examine the mouth for obstructions, bleeding, and any odd odors.
Chest. Examine for injury (cuts, bruises, penetrations, impaled objects, and fractures). Use light compression as a test for fractures. Check for equal expansion (both sides moving equally). Listen with stethoscope for equal breath sounds on each side of chest.
Abdomen. Examine for injury. Check for local and general pain, as you examine the abdomen for tenderness, distention, masses, or rigid areas.
Lower back. Feel for deformity and point tenderness.
Pelvis. Use gentle compression on hips to check for fractures and look for signs of injury.
Genital region. Note any obvious injury. Look for priapism (erection) when assessing male patient suspected of having spinal injury.
Lower extremities. Examine for injury (deformities, swellings, discoloration, bone protrusions, and fractures). Use gentle compression on suspect fracture site. Confirm a pulse in the ankle or foot in each leg. Check each foot for feeling and movement.
Upper extremities. Examine for injury just as in lower extremities. Confirm a radial pulse in each wrist. Check for movement and feeling in hands. Once again, look for medical identification bracelet.
Back surfaces. Examine for bleeding or other injury.
When you have finished your secondary survey you should have a good idea of the seriousness and extent of your patient's illness or injuries. Remember, your patient's condition can potentially deteriorate rapidly and you must periodically repeat your assessments. Once the ten-minute assessment is complete, you are ready for the initiation of care (although in serious cases care is obviously being given simultaneously during the interview and survey).
Without going into detail, the following priority of care example is given as a guide to establish an organized approach to stabilizing your patient. Keep in mind this is only a guide and individual patients or circumstances may modify the priorities.
