When performing a full body scan on a trauma patient, you should assess for deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, and swelling. These eight findings make up the DCAP-BTLS mnemonic, and you check for them at every body region as you move systematically from head to toe. Beyond DCAP-BTLS, each region has its own additional findings to look for, from pupil response in the head to pulse quality in the extremities.
The DCAP-BTLS Mnemonic
DCAP-BTLS is the foundation of the full body scan. Each letter represents a specific finding you’re looking and feeling for at every body region during a head-to-toe assessment:
- D – Deformities: bones or joints that appear misshapen or out of normal alignment
- C – Contusions: bruising, which signals bleeding beneath the skin from blunt force
- A – Abrasions: scrapes where the outer layer of skin has been rubbed away
- P – Punctures: holes in the skin caused by a penetrating object
- B – Burns: thermal, chemical, or electrical damage to the skin
- T – Tenderness: pain when a specific area is touched or palpated
- L – Lacerations: tears or cuts in the skin or soft tissue
- S – Swelling: areas that appear enlarged or puffy, suggesting fluid buildup or inflammation
You apply DCAP-BTLS at each stop in the scan: head, face, neck, chest, abdomen, pelvis, and all four extremities. Think of it as a checklist you repeat at every region rather than something you assess once.
Head and Face
Start by inspecting and palpating the entire scalp. Scalp lacerations and bony step-offs (places where the skull feels uneven, like stair steps under your fingers) can be hidden under hair and are only found through careful touch. Check for hematomas and any areas of depression in the skull.
Palpate the bony margins of the face: the eye sockets, the cheekbones, the nose, and the jawline. Facial fractures can be subtle, so feel for instability or crepitus (a crackling sensation under the skin). Check the nose for a septal hematoma, which looks like a swollen, boggy area inside the nostril.
The eyes need specific attention. Assess pupil size and whether both pupils react equally to light. Check that the eyes move normally in all directions and look for bruising around the eye sockets, sometimes called “raccoon eyes,” which can indicate a fracture at the base of the skull. Examine the ears for blood behind the eardrum and for bruising behind the ear (Battle’s sign). Blood or clear fluid draining from the ear canal also points to a skull base fracture with a spinal fluid leak.
Neck
Inspect and palpate the neck while keeping it carefully immobilized. With blunt trauma, always assume a cervical spine injury until it’s been ruled out. Injuries hiding under a cervical collar can be easy to miss, so check thoroughly when safe to do so.
Feel along the vertebrae at the back of the neck for tenderness, step-offs, or muscle spasm. At the front of the neck, look for swelling, a pulsating mass, or distended neck veins. Also check whether the windpipe sits in the midline or has shifted to one side, which could signal a serious chest injury.
Chest
Palpate the entire chest wall, including the sternum and both collarbones. Fractures in these areas suggest the patient absorbed significant force, which raises concern for deeper injuries to the heart, lungs, or major blood vessels. Feel for crepitus, a bubbly or crackling sensation under the skin that indicates air has leaked out of a lung into the surrounding tissue.
Listen to breath sounds on both sides and compare them. Unequal breath sounds could mean a collapsed lung or blood filling one side of the chest cavity. Listen to heart sounds and note whether they sound muffled, which could indicate fluid collecting around the heart. Look for seatbelt bruising across the chest, since the pattern of bruising often predicts the pattern of internal injury.
Abdomen
Inspect the abdomen for bruising, distension, or visible wounds. Then palpate all four quadrants using light pressure first. You’re feeling for tenderness, rigidity, and guarding. Guarding happens when the abdominal muscles tense up to protect an inflamed or injured organ. It can be voluntary (the patient flinches because it hurts) or involuntary (the muscles lock up on their own because of internal inflammation). Involuntary rigidity, where the abdomen feels board-like and the patient can’t relax the muscles even when asked, is a more serious sign.
Keep in mind that older adults may have weaker abdominal muscles and reduced pain sensation, which can mask rigidity or guarding even when a significant injury is present. A soft abdomen in an elderly trauma patient doesn’t automatically mean everything is fine.
Pelvis
Gently assess pelvic stability by applying light pressure to the iliac crests (the tops of the hip bones). You’re checking for instability, pain, or crepitus. A pelvic fracture can cause life-threatening internal bleeding, so avoid repeatedly compressing the pelvis. If it feels unstable on the first check, don’t test it again.
Extremities
Run through DCAP-BTLS on all four limbs, but the extremities also require a circulation, motor, and sensory (CMS) check. This three-part assessment tells you whether blood flow and nerve function are intact below any injury.
For circulation, feel for pulses at the wrists (radial pulse) and at the tops of the feet (pedal pulse). Check capillary refill at the nail beds by pressing on a fingernail or toenail and counting how long it takes for color to return. Compare pulse strength between the left and right sides. Any weakness or asymmetry is a red flag.
For motor function, ask the patient to wiggle their fingers and toes. In the upper extremities, have them squeeze your hands and note whether grip strength is equal on both sides. In the lower extremities, ask them to push their feet against your hand like pressing a gas pedal, then pull back against resistance. If you suspect a spinal cord injury or stroke, asymmetry in strength between the two sides is a critical finding.
For sensory function, ask whether the patient can feel you touching their fingers and toes. Have them close their eyes and identify which digit you’re pressing on. Ask about numbness or tingling. You can also test whether they can tell the difference between a sharp and dull stimulus. Any loss of sensation, especially in a pattern that affects one side or everything below a certain level, suggests nerve or spinal cord damage.
Neurological Assessment
The Glasgow Coma Scale (GCS) is the standard tool for measuring a patient’s level of consciousness. It scores three categories: eye opening, verbal response, and motor response. The best possible score is 15 (fully alert and oriented), and the lowest is 3 (completely unresponsive).
Eye opening is scored from 1 (no response) to 4 (opens eyes spontaneously). Verbal response ranges from 1 (no sounds) to 5 (oriented, knows who and where they are). Motor response ranges from 1 (no movement) to 6 (follows commands normally). A GCS below 9 generally indicates a severe brain injury, while a score below 13 warrants additional concern and often further imaging.
Beyond the GCS, reassess pupil size and reactivity as part of your neurological check. Unequal pupils or pupils that don’t respond to light can indicate increasing pressure inside the skull.
Posterior Assessment
The full body scan isn’t complete until you’ve examined the back. When safe to do so (typically during a log roll), inspect and palpate the entire posterior surface: the back of the head, the spine, the flanks, the buttocks, and the backs of the legs. Injuries to the posterior are easy to miss if you only assess what you can see from the front. Run through DCAP-BTLS here as well, paying special attention to spinal tenderness or step-offs along the vertebrae.
Skin Assessment
Throughout the full body scan, note the overall condition of the skin. Color, temperature, and moisture give you rapid information about circulation and shock. Pale, cool, clammy skin suggests poor blood flow. Flushed, hot skin could indicate fever or heat-related illness. Cyanosis, a bluish tint especially around the lips and fingertips, signals that oxygen levels are dropping.
If you’re performing a full body skin check for cancer screening rather than trauma, the approach is different. You’re looking at every mole and skin marking using the ABCDE criteria: asymmetry (one half doesn’t match the other), border irregularity (edges that are blurred or jagged), color variation (multiple shades of brown, black, red, or blue within one spot), diameter larger than a pencil eraser, and evolving characteristics (any change in size, shape, color, or new symptoms like itching or bleeding). Pay special attention to areas people commonly overlook: the scalp, behind the ears, the soles of the feet, under the nails, and the genitals. These hidden spots account for a surprising number of missed skin cancers.