2-4
cannon A waves), palpation of pedal and other pulses, and measurement of ankle-brachial index.
Breasts (Chest):
The breasts may be inspected for contour, symmetry, nipple discharge, gynecomastia, and palpated for
lumps/masses and tenderness.
Gastrointestinal:
The abdomen should be inspected for obesity, distention, and scarring, followed by auscultation in all four
quadrants for bowel sounds. Percussion may be performed to detect abdominal tenderness, ascites, or
tympani. Palpation is performed to assess for tenderness, guarding, rebound, and other signs of peritoneal
irritation, enlargement of the spleen or liver, masses, and pulsatile enlargement of the aorta (abdominal aortic
aneurysm). Digital examination of the rectum may be performed to detect hemorrhoids or rectal masses,
assess rectal tone, obtain stool for Hemocult determination, and examine the prostate.
Genitourinary (Male):
External examination of the penis may be performed to detect lesions or discharge. The testicles may be
examined for symmetry, tenderness, masses, hydrocele, or varicocele. The prostate may be assessed for
enlargement, tenderness, or masses during digital rectal examination. The bladder may be palpated to assess
for distention or tenderness.
Genitourinary (Female):
The external genitalia and vagina may be examined for general appearance, estrogen effect, lesions, or
discharge. The cervix may be inspected for lesions or discharge using a speculum, at which time specimens
may be obtained for microscopy and culture. Bimanual examination of the internal GU organs is performed to
detect cervical motion tenderness as well as uterine and/or ovarian enlargement, tenderness, or masses. The
bladder may be palpated to assess for distention or tenderness.
Musculoskeletal:
The spine may be examined for tenderness, range of motion, step-offs, scoliosis, or other deformity. Muscles
may be examined for strength, tenderness, swelling, or spasm. Joints may be examined for range of motion,
tenderness, warmth, discoloration (erythema/ecchymosis), swelling, and instability. Other bones should be
palpated for tenderness, deformity, and crepitus as appropriate.
Neurologic:
The patient should have his mental status assessed (mini-mental status exam) for higher cognitive function
(including level of consciousness). Glasgow Coma Scale is a useful adjunct to assess the current mental
status and progression of trauma victims. Cranial nerves II through XII are routinely assessed as part of
the neurologic examination.
CN II Visual acuity and fields
CN III, IV, and VI Extraocular movements, pupillary reflex (III)
CN V Facial sensation and corneal reflex
CN VII Facial symmetry and strength
CN VIII Hearing
CN IX Gag reflex and reflex palatal movement
CN X Voluntary movement of soft palate or vocal cord function
CN XI Shoulder shrug strength
CN XII Tongue protrusion (midline)
CN I (olfactory) is difficult to assess in the field since this requires testing of smell. Cerebellar function
is tested by having the patient perform actions requiring coordination such as finger/nose or rapid alternating
movements. Motor assessment includes strength and symmetry of major muscle groups. Standard deep
tendon reflexes tested include the knee, ankle, and biceps. Sensation testing may include light touch, pinprick,
vibration, and proprioception. Gait testing is another good measure of central nervous system function.
Psychiatric:
If psychiatric examination is indicated, it should include a number of elements, including a description