How Do You Do the Head-to-Toe Assessment?

Head-to-toe assessment, aka head-to-toe check, is part of the secondary survey. You do a secondary survey when someone is breathing. You’ll check for injuries. Why do we need to do a head-to-toe assessment? How is it done correctly?

This blog will discuss how to do the head-to-toe assessment and why it is important.

Why is a head-to-toe assessment necessary?

A head-to-toe assessment is to quickly and systematically assess injured patients from head to toe, identify all injuries, and evaluate critically ill patients when the cause of their signs and symptoms is unclear.This assessment also obtains pertinent historical data about the patient and their injury.

It evaluates and treats all significant injuries not found during the primary survey by performing a systematic examination.

How to do a head-to-toe assessment?

Check the casualty from head to toe. Protect their dignity and ask permission if possible. Wear disposable gloves and don't move them more than necessary. You need to check from head to toe as follows systematically:

1. Head and neck

  • Has the casualty had an accident that might have injured the spine?
  • Assess the breathing - is it fast or slow, shallow or deep, difficult or normal?
  • Assess the pulse - is it fast or slow, strong or weak, regular or irregular?
  • Check the size of the pupils. Are they equal?
  • Check the whole head and face. Clues to injury could be bruising, swelling, deformity, bleeding or discharge from the ear or nose.

2. Shoulder and chest

  • Compare opposite shoulders and collar bones. Are there signs of fracture?
  • Ask a conscious casualty to take a deep breath.
  • Does the chest move easily and equally on both slides?
  • Does this course hurt?
  • Look for injuries such as stab wounds or bleeding

3. Abdomen

  • Check the abdomen for abnormality or response to pain.
  • Look for incontinence or bleeding
  • DO NOT squeeze or rock the pelvis.

4. Legs and arms

  • Ask a conscious casualty if they can move their arms, legs and joints without causing pain.
  • Check each limb for the sign of a fracture, deformity or bleeding.

5. Clues

  • Look for clues such as medic alert bracelets, needle marks, medication etc.
  • Loosen tight clothing.
  • Have a reliable witness if you check or remove items from pockets or bags. Avoid this if you suspect there could be sharp objects such as needles.

CAUTION: Protecting the airway takes priority. If an unconscious casualty is on their back, you should consider placing them in the recovery position immediately and then complete the head-to-toe check.

Check out this video demonstration to see how a head-to-toe check is done.

What should you be looking for while performing the head-to-toe assessment?

Once you have a general overview, you can start from the top of the body and go down. The assessment is called head to toe for a reason. Some things to look out for are:

  • Hair distribution(even/uneven)
  • Hair infestations (lice, alopecia areata)
  • Bumps, nits, lesions on the scalp
  • Tenderness on scalp
  • Tenderness lumps on the skin
  • Lesions, bruising, or rashes on the skin
  • Temperature, moisture, and skin texture (is the patient pale, clammy, dry, cold, hot, flushed?)
  • Oedema
  • Consistency, colour, and capillary refill of nails
  • Pressure areas.

It is important to remember that some people naturally have unusual body conformation. Be sensitive about this, but don't be afraid to ask the conscious victim or relatives if this is normal for them.It is always worth looking for symmetry - if it is the same on both sides, the chances are, it's normal.

When should we conduct a head-to-toe check on a casualty?

The head-to-toe assessment is performed once the patient has been resuscitated and stabilised. The aim is to detect other significant but not immediately life-threatening injuries. If any deterioration is seen during the examination, reassess the primary survey.

These assessments continually monitor the victim’s condition and find non-life-threatening conditions requiring treatment. A secondary assessment should be done for any victim requiring ambulance intervention or if there is a concern that the victim’s condition may deteriorate.You may sometimes want to do a shortened secondary survey - use your best judgement.

Who is this for?

The Head-to-toe assessment is a technique used by lay rescuers, first responders, and ambulance personnel to identify an injury or illness or determine the extent. It is used on victims who are:

It is used on victims who are:

  • Victim of trauma injuries (except minor injuries affecting peripheral areas, such as a skinned knee or paper cut)
  • Unconscious
  • With a significantly reduced level of consciousness.

Suppose a victim is found unconscious and no history is available. In that case, you should initially assume that the unconsciousness is caused by trauma and, where possible, immobilise the spine until you can establish an alternative cause.

Where can I find online training courses on how do you do the head-to-toe assessment?

The Mandatory Training Group is the leading UK provider of accredited statutory and mandatory training courses for all sectors, including health and social care, education, local government, private companies, charitable and third sector organisations.

Alternatively, you can contact our helpful Support Team byclicking hereto tell us more about head-to-toe assessment training courses and qualifications.

Online first aid training courses, qualifications and programmes

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