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.

John Furst

JOHN FURST is an experienced emergency medical technician and qualified first aid and CPR instructor. John is passionate about first aid and believes everyone should have the skills and confidence to take action in an emergency situation.

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