The extent of the physical examination depends on the severity of the patient’s illness or injuries. The provider should focus first on the primary area of concern before performing a brief head-to-toe examination. 

If the primary concern is respiratory, then the physical examination should first focus on the nose and mouth, chest and lungs, heart, and level of consciousness. The provider may also assess the lungs by auscultating the chest and evaluating for the presence of crackles and wheezes associated with difficulty breathing and intolerance of lying flat in the supine position, which could indicate heart failure. 

If there is a suspected heart condition causing heart failure or arrhythmia, the provider performs a physical examination of the heart, auscultating heart sounds for murmurs and irregularities in rate and rhythm. The clinician examines the abdomen for hepatomegaly and the extremities for the presence of peripheral edema both of which are signs of heart failure. 

If trauma is apparent, the provider surveys the head, neck, chest, abdomen, pelvis, lower and upper extremities, and the patient’s back.