The rush of adrenaline following a car accident can mask pain, leading people to believe they are uninjured even when serious issues exist. Immediate medical evaluation is necessary because doctors follow a systematic approach designed to first rule out immediate threats to life. This step-by-step assessment detects less obvious, yet serious, latent injuries, such as internal bleeding or soft tissue damage, before they cause long-term complications.
Immediate Assessment and Stabilization
The initial focus in an emergency setting is on the immediate survival of the patient, following the established trauma protocol known as the “ABCs” of trauma care. This initial check prioritizes the Airway, Breathing, and Circulation, which are the most time-sensitive life functions. Doctors first confirm a clear airway and then evaluate the rate and quality of the patient’s breathing, looking for symmetrical chest movement.
Medical staff rapidly address Circulation by checking the heart rate, blood pressure, and looking for signs of uncontrolled external or internal bleeding. Checking vital signs helps detect shock caused by significant blood loss. A rapid neurological assessment is also performed using the Glasgow Coma Scale (GCS) to determine the patient’s level of consciousness and responsiveness, helping triage staff understand the severity of any potential brain injury.
Evaluation for Head, Neck, and Spinal Trauma
Once stabilized, the medical examination shifts to a detailed assessment of the head, neck, and spine, which are highly vulnerable in motor vehicle collisions. Doctors perform a thorough neurological exam to check for signs of a traumatic brain injury or spinal cord involvement. This involves testing coordination, muscle strength, deep tendon reflexes, and sensation in all four limbs to localize damage to the nervous system.
A key procedure is the assessment for concussion, where symptoms like headache, dizziness, memory loss, or sensitivity to light are recorded. Cognitive function is tested by asking questions about the accident or recent events, looking for confusion or delayed response. For the neck, doctors check the range of motion and palpate along the cervical spine for tender points, which is a common indicator of soft tissue injury like whiplash.
The process of C-spine clearance determines the stability of the cervical spine. If the patient is alert, has no neck pain or tenderness, and no neurological deficits, a potential fracture may be ruled out without immediate imaging. If pain, altered mental status, or other high-risk factors are present, the neck must be kept immobilized until imaging definitively excludes a fracture or unstable ligamentous injury.
Screening for Internal and Soft Tissue Injuries
Beyond the spine and head, a thorough physical examination targets the torso and extremities to identify internal or musculoskeletal trauma. The doctor examines the chest wall, carefully listening to lung sounds to detect any potential pneumothorax (collapsed lung) or hemothorax (bleeding within the lung space), often caused by rib fractures. They also look for signs of a flail chest, where multiple broken ribs cause a section of the chest wall to move paradoxically.
The abdomen is systematically palpated to check for tenderness, rigidity, or distension, which can signal internal bleeding or damage to organs like the spleen or liver. Since the pain from visceral injuries can be delayed or referred, a deep and careful touch is necessary to identify subtle signs of injury. The pelvis is also assessed for instability, as pelvic fractures can lead to massive, life-threatening internal blood loss.
The extremities are checked for fractures, dislocations, and significant soft tissue injuries. This involves inspecting for swelling, bruising, and deformity, and testing the range of motion and vascular status of the arms and legs. Injuries to muscles, tendons, and ligaments are identified by noting localized pain or instability during movement, as these are often masked by adrenaline immediately after the crash.
Diagnostic Imaging and Testing
To confirm or rule out injuries suspected during the physical examination, doctors use specific imaging and laboratory tests. X-rays are generally the first line of imaging, providing quick visualization of bones to identify fractures and dislocations in the limbs or spine. They are particularly effective for checking the integrity of the skeletal structure.
For more complex or internal injuries, a Computed Tomography (CT) scan is often ordered, which uses specialized X-ray technology to create detailed cross-sectional images. CT scans are the preferred tool for rapidly assessing the brain for bleeding or swelling, and for visualizing internal organs in the chest and abdomen for signs of trauma. Magnetic Resonance Imaging (MRI) is used when there is concern for soft tissue damage, providing high-resolution images of the spinal cord, intervertebral discs, ligaments, and tendons.
Laboratory work is also an important part of the diagnostic process. Blood tests are conducted to check hemoglobin and hematocrit levels, which indicate the severity of any internal bleeding. Other blood markers help assess organ function and the body’s systemic response to trauma. Ultrasound is sometimes used, particularly a Focused Assessment with Sonography for Trauma (FAST) exam, which quickly checks for free fluid or blood around the heart and abdominal organs.