| Anatomic region/structure/function | Key examination points | Findings |
| ABCs Vital signs | - Reassess airway
- Repeat vital sign measurements
- Reassess neurologic status
| |
| Head and face | - Inspect head, scalp, and face (eg, hemotympanum, retro-auricular ecchymosis, nasal CSF, nasal septal hematoma)
- Inspect mouth and oral cavity (eg, lacerations, loose teeth, jaw malocclusion)
- Palpate, including all bony structures (eg, deformity, step-off, foreign body, lacerations)
| |
| Eyes | - Visual activity
- Pupillary size, shape, reactivity
- Extraocular motions
- Inspect, directly and with ophthalmoscope (eg, globe rupture, intraocular hemorrhage)
- Measure pH if possible, alkali burn from airbag injury
- Ocular ultrasound if no sign of global rupture and concern for retinal detachment
- Ocular pressure measurement if concern about compartment syndrome
| |
| Neck | - Assume c-spine injury present until ruled out by CDR or imaging
- Inspect and palpate entire cervical spine and neck (eg, swelling, crepitus, pulsatile mass)
| |
| Chest | - Inspect and palpate chest wall for deformity, tenderness, crepitus, including sternum, clavicles, rib cage (don't miss axillary and other skin folds)
- Auscultate lungs and heart (eg, hemothorax, pneumothorax, pericardial effusion)
| |
| Back | - Inspect and palpate back, including thoracic and lumbar spine for step-off, deformity, point tenderness
- Inspect and palpate ribcage and scapulae for deformity and tenderness
- Inspect and palpate CVA for tenderness
| |
| Abdomen and pelvis | - Inspect abdomen for lacerations, contusions, ecchymosis (don't miss abdominal folds)
- Palpate for tenderness, distension, rigidity, pelvic stability (absence of tenderness does not rule out injury, particularly in patients that are older, altered, or distracted by other injuries)
| |
| Perineum and genitourinary | - Inspect genitalia and perineum (eg, blood at meatus; don't miss gluteal folds)
- Perform rectal examination if spinal cord injury or pelvic fracture known or suspected
- Perform vaginal examinations if signs or suspicion for internal injury or known injury (eg, pelvic fracture)
| |
| Extremities | - Inspect and palpate all extremities, including entire length of long bones (don't miss compartment syndrome or distal fractures)
- Assess sensorimotor function
- When possible, assess passive and active ROM for all joints
| |
| Vascular and skin | - Assess distal pulses and capillary refill of all extremities
- Assess skin color and temperature, especially of extremities (don't miss early signs of shock: pallor, cool clammy skin)
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