Step 11.—Inspect the chest for wounds. Exposethe chest. For unconscious and trauma patients, youshould completely remove clothing to expose thechest. (Try to provide as much privacy as possible forpatients.) Look for obvious chest injuries, such as cuts,bruises, penetrations, objects impaled in the chest,deformities, burns, or rashes. If puncture or bulletwounds are found, check for exit wounds wheninspecting the back.Step 12.—Examine the chest for possiblefracture. Before you begin examining the chest forfractures, warn the patient that the examination may bepainful. Begin your examination by gently feeling theclavicles (collarbones). Next, feel the sternum(breastbone). Then examine the rib cage by placingyour hands on both sides of the rib cage and applyinggentle pressure. This process is known ascompression. If the patient has a fracture,compression of the rib cage will cause pain. Finally,slide your hands under the patient’s scapulae (shoulderblades) to feel for deformities or tenderness.Point tenderness, painful reaction to compression,deformity, or grating sounds indicate a fracture. If airis felt (like crunching popcorn) or heard (cracklingsounds) under the skin, this indicates that at least onerib is fractured or that there is a pneumothorax(punctured lung). You may also observe air escapingthe chest cavity and the wound when the patient has apunctured lung.Step 13.—Check for equal expansion of thechest.Check chest movements and feel for equalexpansion by placing your hand on both sides of thechest. Be alert to sections of the chest that seem to be“floating” (flail chest) or moving in a directionopposite 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 anteriorand lateral chest. The sounds of air entry will usuallybe clearly present or clearly absent. The absence of airmovement indicates an obstruction, injury, or illness tothe respiratory system. Bubbling, wheezing, rubbing,or crackling sounds may indicate the patient has amedical problem or a trauma-related injury.Step 15.—Inspect the abdomen for wounds.Look for obvious signs of injury (e.g., abdominaldistension, cuts, bruises, penetrations, open woundswith protruding organs (evisceration), or burns) in allfour 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 theentire abdomen. If the patient complains of pain in anarea of the abdomen, palpate that area last. Do notpalpate over an obvious injury site or where the patientis having severe pain. While palpating the abdomen,check for any tight (rigid) or swollen (distended) areas.Performing abdominal palpation is important becausetender areas do not normally hurt until palpated. Noteif pain is localized, general, or diffused.Step 17.—Feel the lower back for pointtenderness and deformity. Gently slide your handsunder the void created by the curve of the spine. Applygentle pressure to detect point tenderness or anydeformities.NOTE: This examination of the lower backmay be performed later, when the patient’sentire back is exposed in preparation to beingplaced on a backboard or stretcher.Step 18.—Examine the pelvis for injuries andpossible fractures.Examine the pelvic area forobvious injuries. Next, gently slide your hand downboth sides of the small of the patient’s back and applycompression downward and then inward to check thestability of the pelvic girdle. Note any painfulresponses or deformities. If a grating sound is heard,the injury may involve the hip joint, or the pelvis maybe fractured.Step 19.—Note any obvious injury to the genitalregion. Look for obvious injuries, such as bleedingwounds, objects impaled in the area, or burns. Also,check for priapism in male patients. Priapism is apersistent erection of the penis often brought about byspinal injury or certain medical problems, such assickle cell crisis.Step 20.—Examine the lower extremities. DONOT move, lift, or rearrange the patient’s lowerextremities (legs and feet) before or during theexamination as further injury to the patient may occur.Check for signs of injury by inspecting each limb, oneat a time, from hip to foot. Rearrange or removeclothing and footwear to observe the entireexamination site. Pants should be removed in amanner that does not aggravate injuries. Cutting alongthe seams to remove pants is the best method. If theinjury is not obvious, remove the shoe(s) and palpateany suspected fracture sites for point tenderness.Before palpating the site, warn the patient that thisexamination may cause pain. Before the patient is4-8
Integrated Publishing, Inc. - A (SDVOSB) Service Disabled Veteran Owned Small Business