Step 11.Inspect the chest for wounds. Expose
the chest. For unconscious and trauma patients, you
should completely remove clothing to expose the
chest. (Try to provide as much privacy as possible for
patients.) Look for obvious chest injuries, such as cuts,
bruises, penetrations, objects impaled in the chest,
deformities, burns, or rashes. If puncture or bullet
wounds are found, check for exit wounds when
inspecting the back.
Step 12.Examine the chest for possible
fracture. Before you begin examining the chest for
fractures, warn the patient that the examination may be
painful. Begin your examination by gently feeling the
Next, feel the sternum
(breastbone). Then examine the rib cage by placing
your hands on both sides of the rib cage and applying
This process is known as
If the patient has a fracture,
compression of the rib cage will cause pain. Finally,
slide your hands under the patients scapulae (shoulder
blades) to feel for deformities or tenderness.
Point tenderness, painful reaction to compression,
deformity, or grating sounds indicate a fracture. If air
is felt (like crunching popcorn) or heard (crackling
sounds) under the skin, this indicates that at least one
rib is fractured or that there is a pneumothorax
(punctured lung). You may also observe air escaping
the chest cavity and the wound when the patient has a
Step 13.Check for equal expansion of the
Check chest movements and feel for equal
expansion by placing your hand on both sides of the
chest. Be alert to sections of the chest that seem to be
floating (flail chest) or moving in a direction
opposite to the rest of the chest during respiration.
Step 14.Listen for sounds of equal air entry.
Using a stethoscope, listen to both sides of the anterior
and lateral chest. The sounds of air entry will usually
be clearly present or clearly absent. The absence of air
movement indicates an obstruction, injury, or illness to
the respiratory system. Bubbling, wheezing, rubbing,
or crackling sounds may indicate the patient has a
medical problem or a trauma-related injury.
Step 15.Inspect the abdomen for wounds.
Look for obvious signs of injury (e.g., abdominal
distension, cuts, bruises, penetrations, open wounds
with protruding organs (evisceration), or burns) in all
four quadrants and sides.
Step 16.Palpate the abdomen for tenderness.
Look for attempts by the patient to protect his abdomen
(e.g., patient drawing up the legs). Gently palpate the
entire abdomen. If the patient complains of pain in an
area of the abdomen, palpate that area last. Do not
palpate over an obvious injury site or where the patient
is having severe pain. While palpating the abdomen,
check for any tight (rigid) or swollen (distended) areas.
Performing abdominal palpation is important because
tender areas do not normally hurt until palpated. Note
if pain is localized, general, or diffused.
Step 17.Feel the lower back for point
tenderness and deformity. Gently slide your hands
under the void created by the curve of the spine. Apply
gentle pressure to detect point tenderness or any
NOTE: This examination of the lower back
may be performed later, when the patients
entire back is exposed in preparation to being
placed on a backboard or stretcher.
Step 18.Examine the pelvis for injuries and
Examine the pelvic area for
obvious injuries. Next, gently slide your hand down
both sides of the small of the patients back and apply
compression downward and then inward to check the
stability of the pelvic girdle.
Note any painful
responses or deformities. If a grating sound is heard,
the injury may involve the hip joint, or the pelvis may
Step 19.Note any obvious injury to the genital
region. Look for obvious injuries, such as bleeding
wounds, objects impaled in the area, or burns. Also,
check for priapism in male patients. Priapism is a
persistent erection of the penis often brought about by
spinal injury or certain medical problems, such as
sickle cell crisis.
Step 20.Examine the lower extremities. DO
NOT move, lift, or rearrange the patients lower
extremities (legs and feet) before or during the
examination as further injury to the patient may occur.
Check for signs of injury by inspecting each limb, one
at a time, from hip to foot.
Rearrange or remove
clothing and footwear to observe the entire
Pants should be removed in a
manner that does not aggravate injuries. Cutting along
the seams to remove pants is the best method. If the
injury is not obvious, remove the shoe(s) and palpate
any suspected fracture sites for point tenderness.
Before palpating the site, warn the patient that this
examination may cause pain. Before the patient is