How to Complete a Top to Toe Assessment of an Injury

Top-to-toe assessments can be extremely important if you find yourself in an emergency situation. It can provide vital information to an ambulance crew before or when they reach the scene of an accident.

Steps

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    First check the airway, breathing and circulation. If they are not breathing or have no pulse, begin rescue breathing or CPR.
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    Starting at the head, look and feel for any lumps or bumps, being careful not to move the injured person/ change position of spine. Are they bleeding? Is there any dried blood? At this point, you should also be checking the face for any pain response.
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    Check the eyes for dilation (this may indicate any brain damage incurred). Are they blood shot?
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    Check for their level of consciousness by asking,"are you alright?", "can you hear me?" Continue by tapping on the shoulder, but be careful not to move the neck if a spinal injury is suspected.
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    Checking the face: is the colour abnormal? Is the skin Patchy? does the temperature feel okay? Is the skin moist or clammy? Is there any swelling or disfigurement? Are there any pain responses?
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    Checking the ears: Check for injury and then look inside the ears. If there is a sticky straw coloured fluid leaking, this may be a sign of spinal injury; DO NOT touch this fluid and DO NOT stop it from flowing.
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    Checking the mouth: Are the lips blue? This could be a sign of poor circulation, also called cyanosis. How does the breath smell? Could the casualty have consumed alcohol, or inhaled glue or another gas? If the breath smells of pear drops or acetone this could be a sign that the casualty is diabetic and in some form of shock.
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    Checking the neck: Feel for bulging. Are there any cuts or swelling? Check firmness to touch. This could indicate internal bleeding. Check to make sure that the trachea is going down the middle of the neck. A windpipe that is off to the side could indicate air in the chest that is outside of the lung.
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    Checking the Ribcage: feel the ribcage firmly, checking for any grinding or disfigurement that could indicate broken bones.
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    Checking the stomach: Again, check for firmness/tenderness and any bulging in four sections of the abdomen. This could be trapped air, or internal bleeding.
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    Checking the hips: Rock the hips gently from side-to-side and push down to check that they move freely and are not dislocated.
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    If you must examine the genitals, do so quickly and accurately. Never skip this part when necessary just because of invading patient privacy, but then again respect the patient's privacy as much as possible.
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    Checking the legs: Gradually move down the legs feeling for any grinding or visible disfigurement. Is there any swelling? Any cuts or contusions (bruises)? Try to find a pulse in the foot(just around the top where the foot meets the ankle); is there a presence or absence of a pulse?
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    Checking the arms: Follow the same steps as checking the legs but also; check for needle marks, check for ID bracelet or medi-tag, press nail beds and check that they turn white and then pink (this is commonly referred to as capillary refill). If it takes more than two seconds for the nailbeds to return to their original color, this could be a sign of poor circulation. Check for a pulse in the wrist; is there a presence or absence of a pulse?

Tips

  • Ensure that there is a witness present. If you need to remove any clothing or items from the casualty's pockets to complete assessment, you will want someone to vouch that you didn't steal anything or touch them inappropriately.
  • Take your time - it is not a race. It is important to be as thorough as you can, so you can give the Emergency Medical Personnel as much information as possible. Spend at least 2 minutes on the head and face.
  • Remember - always dial an emergency hotline such as 999 or 911 or ensure that someone else is coming before beginning your assessment.
  • Considering the fact that adults can have a bit of poor circulation because an adult is not as regulated and may take medications, DO NOT use capillary refill on adults; please use it only on children who have not reached puberty (usually age 8 or under)

Warnings

  • Please check that it is safe to approach the injured person before doing so. Failure to do so will result in you or others also getting hurt in addition to the patient. Look around and make sure that the scene is safe for you, the patient, and other possible bystanders.
  • These tips are to help you to help the Emergency Medical Personnel, they are not designed to give you any kind of first aid training or qualification(s).
  • Do not attempt CPR unless properly trained.certified to do so, even if the patient is not breathing; doing so can cause death and/or serious further injury.

Article Info

Categories: First Aid and Emergencies