Head to Toe Exam

Tom RaderStaff - June 8, 2021

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• Wiggling fingers – what type of information does this give, or what would I change or do if the answer changed?
• Four quadrants of the stomach/abdomen – What organs might be affected, or what would I do depending on the answer? Is this something I should just read in a IFAK medical reference? Or is this intended more as “write it down in case you need to tell a medical professional later”?

 

Great questions. This overall step is more about helping you go from “there’s a million potential reasons for this person being in trouble… at least I can narrow it down to a few potentials based on obvious warning flags.” I’ve updated the text today, but specifically:

Wiggling fingers/toes is simply an easy way to see if there are broken bones in the region or if there’s muscle/nerve/soft tissue damage that’s inhibiting the movement. If you found some kind of signal that tells you it’s worth investigating more, then you would use the deeper skills discussed in the relevant paths, eg. muscle-skeletal or spine lessons.

You’re correct on the abdomen. In this step, it’s more about identifying that there’s a problem, and that info might help you look up info in a reference book (if alone) or communicate to the pros. 

For example, you might feel that a part of the belly is unusually hard/stiff, perhaps with some bruising. That’s a big warning flag for internal bleeding, and you’d focus in on / act about that data accordingly.

 

Hi all! This is great stuff! I have a question about procedure, and where this head-to-toe exam fits in with it. Assuming that I find an unresponsive person in the woods (and have already surveyed the scene, tried to wake the person, and made the 911 call), what should my order of operations be? Let’s say I’ve got to do the following: A) comprehensive head-to-toe check,  B) pulse and breathing check, C) apply tourniquet to missing limb, and D) CPR/rescue breathing. What would your order be? Thanks!

 

Here’s the timeline of what my natural reaction would be for that scenario:

1. Find someone unresponsive in the woods.
2. Look around for any glaring signs of what might have happened (hunter fell out of a tree stand, missing foot and an axe and pile of chopped wood next to the body…).
3. If there was a missing limb and I had a tourniquet, I would apply that ASAP. Preventing them from bleeding out is #1 priority.
4. Shake them, yell loudly to try and wake them up, check pulse and breathing while doing so.
5. Apply CPR/rescue breathing while calling 911 on speaker phone. If I had a companion with me, they would have been calling 911 during the 3rd step while I applied the tourniquet.
6. Comprehensive head-to-toe check.

 

Broadly speaking, the head-to-toe exam comes after the initial “is this person about to die?” actions. That’s why this lesson is included in the “Secondary Survey” section, where “Primary Survey” covers the Blood Claw and the CABCs (catastrophic bleeding, airway, breathing, circulation.) 

So if you find an unresponsive person, and you don’t know what’s wrong / what happened, you start with Blood Claw and CABCs. If you find something wrong during those checks, such as the patient not breathing or bleeding out, you immediately act on those time-critical threats. 

It’s once you’re confident the patient is not about to die that you do a head-to-toe. 

Make sense? Very important concepts, so glad you asked.