Secondary Assessments (Head to Toe Exam)

Question 1

Hint: use H-Shs-Kns&Ts to remember key checkpoints!

What is the first step of a Secondary Assessment?

Answer 1

The Head-to-Toe exam!

Question 2

What should you check during a Head-to-Toe exam?

Answer 2

HEAD: Scalp, eyes, nose and mouth;
SHOULDERS: Neck and base of skull, collarbones and shoulders, arms and wrists, spine, ribs, abdomen;
KNEES: Pelvis, groin, legs.
TOES: Hands and fingers, feet (includes ankles) and toes.

Question 3

HEAD: What to check for during the H-to-T scalp exam?

Answer 3

Bumps, swelling, bruising, and bleeding

Question 4

HEAD: What to check for during the H-to-T eye exam?

Answer 4

The pupils (equal and responsive to light) and bruising around the eyes

Question 5

HEAD: What to check for during the H-to-T nose and mouth exam?

Answer 5

Breathing (quality), odors (from alcohol or poison), excess fluid (i.e. vomit, foam, etc.), and bleeding

Question 6

HEAD: What to check for during the H-to-T ear exam?

Answer 6

Fluid (CSF leaks), bruises, and bleeding

Question 7

SHOULDERS: What to check for during the H-to-T neck and skull exam?

Answer 7

Bumps, bruises, and MedID necklaces

Question 8

SHOULDERS: What to check for during the H-to-T collarbone/shoulder exam?

Answer 8

Bumps, bruises, and (a)symmetry

Question 9

SHOULDERS: What to check for during the H-to-T arm exam?

Answer 9

Bumps, bruises, and (a)symmetry

Question 10

SHOULDERS: What to check for during the H-to-T wrist exam?

Answer 10

Bumps, bruises, (a)symmetry, and MedID bracelets

Question 11

SHOULDERS: What to check for during the H-to-T spine exam?

Answer 11

Bumps and bruises

Question 12

SHOULDERS: What to check for during the H-to-T rib exam?

Answer 12

Bumps, bruises, (a)symmetry, and proper/full expansion (able to take deep breaths without issue)

Question 13

SHOULDERS: What to check for during the H-to-T abdomen exam?

Answer 13

Bruising, distension (gas in the intestinal tract/stomach), and rigidity

Question 14

KNEES: What to check for during the H-to-T pelvis exam?

Answer 14

Stability and (a)symmetry

Question 16

KNEES: What to check for during the H-to-T groin exam?

Answer 16

Check for bleeding, as well as loss of control of bladder and/or bowels

Question 17

KNEES: What to check for during the H-to-T leg exam?

Answer 17

Bumps, bruises, (a)symmetry, and ability to move (bending, twisting, etc.)

Question 18

TOES: What to check for during the H-to-T hands and fingers exam?

Answer 18

HANDS: Bumps, bruises, (a)symmetry, strength (assess grip and dexterity), and reaction to pain (pinching/gripping)
FINGERS: Bumps, bruises, colour, temperature/circulation

Question 19

TOES: What to check for during the H-to-T feet and toes exam?

Answer 19

FEET: Bumps, bruises, (a)symmetry, colour, temperature, reaction to pain (pinching and/or gripping), and any MedID bracelets/anklets
TOES: Bumps, bruises, temperature/circulation, and (return of) colour