Emergency response: Assessing the patient from head to toe

This is the last in a series of articles on what to do when you encounter an injured person and you want to help them.

After you've initially assessed the patient, you can go into greater detail.

When doing head to toe assessment, you start from the head down to the toe, looking for the following:

• Deformity
• Contusion (bruise)
• Abrasion
• Puncture
• Burn
• Tenderness
• Laceration
• Swelling

Say something like:

Hi so-and-so, my name is so-and-so and I am part of the Emergency Response Team. Respond to me verbally only. Do not move your head at any time, OK? I am going to do a head-to-toe assessment, where I am going to prod around your body. Is that OK? (Ask another person to do Cspine)

Check the following in the main body:

1. Eyes - Pupil dilating?
2. Mouth - Nothing obstructing or bleeding.
3. Fluid - Saliva or spinal fluid, which has no color. 
4. Neck
   
   • No tracheal deviation, it's central. If you injured your lungs, trachea deviates to the good lung. 
   • No medical alert necklace 
   • No jugular vein bulging out. If there is, blood flow is backing up.
5. Chest
   
   • See if entire chest is moving in unison. 
   • Intercostal bulging or depression (shirt off, if needed).
   • Check for punctures
   • Barrel hoop (underneath the nipple line, you squeeze the rib cage and see if there's pain. 
   • Another barrel hoop, this time ask them to breathe in and out.
6. Abdomen - Palpitate in each quadrant. Ask patient to tell you if they feel pain when you push down and release.
7. Pelvis - Barrel hoop; no need to do second time with deep breathing. 



Now that we are done with the core of the body, we'll move on to extremities.

1. Leg - Squeeze all the way down.
2. Feet
   
   • Take shoes and socks off
   • Take PMS - pulse, movement, and sensation. For movement, make them wiggle toes. For sensation, touch only the extremes, big toe and little toe, and ask them which one you are touching. Ignore the in-between toes, most people can't tell them apart.
3. Arms - Look for track marks, needle marks, and do PMS.
4. Back - Roll the person with at least three people. With one person on Cspine and doing the call and count (they're the one who should be ready!). Look for bruising or pooling of blood.