Performing a thorough head to toe assessment (sometimes called a ‘body check’) is an important step in the secondary survey. 

Systematically searching the patient, region by region, first aiders should make a note of all injuries, starting at the head and proceeding through the neck, chest and abdomen to the extremities.

Head

Look for:

• lacerations and bruising
• blood or cerebrospinal fluid from the ears or nose
• re-check pupil size and response
• pallor and sweating
• cyanosis

Feel for: 

• scalp hematomas (swellings)
• depressed skull fractures
• facial tenderness and fractures

Listen for:

• airway noise suggesting obstruction 
• breathing adequacy and rate

Neck

Look and feel for:

• lacerations and contusions
• surgical emphysema
• spinal deformity, tenderness or hematoma
• re-check pulse rate and strength

 

Chest

Look for:

• wounds and evidence of penetrating injury
• deformity and abnormal movements
• breathing distress and pain on breathing

Feel for:

• tenderness
• instability of a flail segment (multiple rib fractures)
• surgical emphysema (air under the skin)

Abdomen

Look for:

• penetrating wounds and contusions
• seat-belt contusions and clothing imprints
• distension

Feel for:

• tenderness, either localised or generalised
• guarding − involuntary muscle spasm on gentle palpation.

 

Extremities (limbs)

Look for:

• obvious wounds and contusions
• deformity and swelling associated with fractures
• voluntary movement

Feel for:

• tenderness and deformity
• distal pulses
• intact nerve supply – sensation to touch and pain, motor function
• normal movements in joints.