How to perform a head to toe assessment

First aid for head injuriesPerforming 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.


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


Look and feel for:

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



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)


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.

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