The neck should be inspected for gross venous distention, tracheal deviation, crepitus, and penetrating wounds. Likewise, the chest should be inspected for retractions, sucking wounds, and flail segments. Auscultation for full, symmetric breath sounds bilaterally should be completed, as should palpation for crepitus. Pneumothorax, a life-threatening condition where free air escapes into the lung cavity, causing lung and great vessel compression must be ruled out. If the patient is intubated, post-intubation auscultation should be performed to ensure adequate placement of the endotracheal tube.
Circulation is assessed using several clinical clues.
Evaluation of skin color, capillary refill, mental status, and pulse rate are all valuable in assessing circulation. Hemorrhage should be assumed in any hypotensive trauma patient until proven otherwise. Two large bore IV's should be established if possible. Both systolic and diastolic blood pressures are important in the trauma evaluation. Response to fluid resuscitation should be closely monitored.