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  • Inspect from head to toe for both trauma signs (DCAP-BTLS) and medical signs.
  • Only perform the detailed exam there are no life-threatening conditions to be managed.
  • You are not required to perform a detailed physical exam for every patient.
  • Head: look for DCAP-BTLS to the skull and scalp.
  • Ear
    • Look inside the ear for CSF leakage, which indicates skull fracture.
    • Allow any CSF to leak onto a loose dressing.
    • CSF contains glucose, which can be detected by a glucometer.
    • Look behind the ear (mastoid process). Black-and-blue discoloration (Ecchymosis) is called the Battle's sign, which is a late sign of head injury.
  • Face
    • Look for facial deformities / bleeding that may obstruct the airway.
    • Burns to the face may indicate burns to the upper airway, which may cause swelling and constriction of the airway.
  • Eyes
    • Test for consensual reflex (normally, both pupils should respond when light is shined onto one pupil).
    • Pupil response to light should be fast. Sluggish response indicates poor perfusion to the brain, high CO2 levels and brain injuries.
    • Unequal pupils indicate head injury or stroke.
    • Fixed and dilated pupils indicate possible cardiac arrest or severe head injury.
    • Pinpoint pupils indicate narcotic influence.
    • Check for visual acuity: "how many fingers am I holding up?"
    • Check for conjugate movement: eyes should move smoothly and together. Jerky eye movements (nystagmus) indicates drug influence or CNS problems. Dysconjugate gaze indicates injuries to eye or nerve.
  • Nose
    • Look for deformities and burns that may indicate airway compromise.
    • Leakage of CSF indicates skull fracture.
    • Nasal flaring is a sign of inadequate breathing.
  • Mouth
    • Inspect for and manage injuries that may cause airway compromise.
    • Bite injuries to tongue indicate possible seizure / epilepsy.
    • Cyanosis to the oral membranes indicate hypoxia.
    • Pale tongue may indicate shock.
    • Burns / white areas indicate ingestion of caustic substances / poison.
    • Alcoholic odors indicate alcohol intoxication.
    • Fruity odors indicate a diabetic emergency.
    • Unusual / chemical odors may indicate substance abuse.
  • Neck
    • Open wounds need to be covered with occlusive dressing to prevent air being sucked into vein.
    • JVD indicates heart failure or compression due to tension pneumothorax.
    • Tracheal deviation is a late sign for tension pneumothorax.
    • Crepitations are caused by air under the skin called subcutaneous emphysema. They indicate respiratory trauma.
    • Use of neck muscles to breath and tracheal tugging indicate respiratory distress.
  • Chest
    • Check for retractions, which indicate respiratory distress.
    • Look and feel for equal chest rise. Unequal chest rise indicates injuries to one side such as pneumothorax and flail segments.
    • Paradoxical movement and flail segments need stabilization.
    • Auscultate for breath sounds.
    • Wheezing indicates constriction of bronchioles. When wheezing is isolated to a specific area, it indicates a localized infection or obstruction.
    • Stridor: upper airway obstruction.
    • Crackles / rales are caused by fluids in the lung.
    • Rhonchi (snoring sound upon auscultation) are caused by mucus in the airway.
    • Coughing blood indicates lung injury. Yellow or green sputum indicates infection.
  • Abdomen
    • Patients in a defensive position complaining of abdominal pain indicates peritoneum irritation.
    • Patients who can freely move about and complains of abdominal pain indicates bowel obstruction.
    • Tenderness, rigidity, discoloration are signs of internal bleeding.
    • Guarding, rigidity, and shallow breaths are signs of peritonitis.
    • Pulsating mass in the abdomen indicates weakened abdominal aorta.
    • Cover eviscerations with most sterile dressing and seal it with an occlusive dressing.
  • Pelvis
    • Assess for pelvic stability. Pelvic fractures can cause significant internal bleeding.
    • Priapism (persistent erection) is a sign of spinal cord injury.
    • Note any bleeding and loss of bladder control.
  • Lower extremities
    • PMS: presence dorsalis pedis pulse, both feet can push down with equal strength, can feel both touch and pain (pinch) to the foot and also locate which side the was touched/pinched.
    • Hemiplegia: paralysis to one side. This is a sign for stroke.
    • Paraplegia: paralysis involving both legs only.
    • Quadriplegia: paralysis involving both arms and both legs.
  • Upper extremities
    • PMS: presence radial pulse, both hands can wiggle their fingers and grip with equal strength, can feel and locate both touch and pain.
    • Unequal grips is a sign for stroke.
  • Back
    • Just like everything else, assess for trauma signs.
    • Muscle spasms around the vertebrae is a sign of spinal injury.
    • Maintain an in-line stabilization.
  • Reassess Vital Signs
    • Every 5 minutes for unstable patients.
    • Every 15 minutes for stable patients.