Inspect the face and scalp. Look for any lacerations and bruising including mastoid or periorbital bruising, which is indicative of a base of skull fracture. Gently palpate for any depressions or irregularities in the skull.
Look in the eyes for any foreign body, subconjunctival haemorrhage, hyphaema, irregular iris, penetrating injury or contact lenses.
Assess the ears for any signs of a cerebrospinal fluid leak, bleeding or blood behind the tympanic membrane. Check the nose for any deformities, bleeding, nasal septal haematoma or cerebrospinal fluid leak.
Look in the mouth for any lacerations to the gums, lips, tongue or palate. Note any swelling, which may indicate an inhalation injury. Inspect the teeth, noting if any are loose, fractured or missing.
Test eye movements, pupillary reflexes, vision and hearing.Palpate the bony margins of the orbit, maxilla, nose and jaw. Inspect the jaw for any pain or trismus.
To assist with adequate access, ensure another colleague maintains manual in-line stabilisation while the collar is removed and throughout the examination.
Gently palpate the cervical vertebrae. Note any cervical spine pain, tenderness or deformity. Check the soft tissues for bruising, pain and tenderness.
Complete the neck examination by observing the neck veins for distension and palpating the trachea and the carotid pulse; note any tracheal deviation or crepitus.
The patient will need to be log rolled to complete the full examination. This can be combined with the back examination.
Inspect the chest, observing movements. Look for any bruising, lacerations, penetrating injury or tenderness.
Palpate for clavicle or rib tenderness.
Auscultate the lung fields; note any percussion, lack of breath sounds, wheezing or crepitations.
Check the heart sounds: apex beat and presence and quality of heart sounds.
Inspect all the limbs and joints. Palpate for bony and soft tissue tenderness and check joint movements, stability and muscular power. Note any bruising, lacerations, muscle, nerve or tendon damage. Look for any deformities, penetrating injuries or open fractures.
Examine sensory and motor function of any nerve roots or peripheral nerves that may have been injured.
Assess distal perfusion for capillary refill, pulse and warmth.
Log roll the patient. Maintain in-line stabilisation throughout. Inspect the entire length of the back and buttocks noting any bruising and lacerations.
Palpate the spine for any tenderness or steps between the vertebrae. Include a cervical examination at this stage.
Digital examination should be performed only if a spinal injury is suspected. Note any loss of tone or sensation.