Q. Would you turn to your notes of your examination? In the systems review I notice that there is a line across. You did no systems review? A. No, and that's generally not done in trauma patients. Q. What's the reason? A. Lack of time. Q. Am I correct that your actual notes begin where it says physical examination? A. Right. Q. Here? A. Yes. Q. All of the handwriting is that yours that goes on until the end? A. Yes. It's all mine. Q. Where your signature appears, five or six pages later? A. Yes. Q. Am I correct the first thing you checked was his pulls which are in the same place? A. Yes. But those are on the monitor because at the time that they were brought into the emergency room, the nurse places them on a monitor. Q. So at the time you first saw him, the pulse was 104? Is that what it says, 104, 107? A. 104. Q. For a patient that has the history you knew this patient had, was that normal? A. Yes. Q. Blood pressure is listed as 147 over 74, is that within normal limits? A. Yes. Q. Respirations are listed as 20, is that within normal limits? A. That's normal. Q. Can you read for me what you have under general description? A. Thin male, alternately somnolent and combative. Q. That was something that you observed? A. Yes. Q. Could you tell me what significance, if any, that had to you in terms of his condition? A. He was not cooperative with the procedures we were doing and although he was answering questions appropriately, he was not fully alert and that to me suggested the possibility of a head injury. He had a mechanism for head injury. Q. You then did an examination of the skin and found it to be normal? A. Yes. Q. Is that what the check mark means? A. Yes. Q. Lymph nodes, do you found--you found those to be normal? A. Yes. Q. These you did by palpation? A. Yes. Q. Under "head," could you tell me what you have written for that? A. Abrasions and ecchymosis to forehead. Q. Did he appear to have any open wounds? A. Abrasion is an open wound because the skin is open. Q. You circled the word "trauma." Can you tell me the reason you did that? A. Because this was related to trauma. According to the EMS people, he had hit his head on the windshield, causing the wind shield to shatter. Q. Am I correct that in an area like this one, where it says "head" and you circled that and nothing else, does that mean you found no bruise, no tenderness or no other? A. He probably had tenderness, but I tend not to press on open wounds. Q. You next examined his eyes? A. Yes. Q. Would you tell me how you did that? A. By looking into them and using a light. Q. What was the nature of what you found when you examined his eyes? A. Those initials stand for pupils equal, reactive to light; equal, round and reactive to lights. Q. Were you able to see the fundus? A. We do not do funduscopic exams. Q. How far into the eye do you see when you do this kind of examination in the emergency room? A. They do not use the ophthalmoscope. When we look into the eye we just look into the eye surface and the pupils of the eye. Q. Can you tell me what the reason is that no fundoscopic examination was done? A. This was a preliminary survey and trauma. It has to be done in one minute, so it's a very quick overview. Q. His ears you found to be normal? A. Yes. Q. You examined his nose. How did you do that? A. I didn't look inside of his nose, but he had a small amount of blood coming from one nostril. We generally examine the face for any bony deformities, which he did not have. Q. Throat and mouth, you check off as being normal, correct? And the neck, how did you examine that? A. By inspection and palpation. Q. You found no abnormalities in the neck? A. Correct. Q. The next thing would be the respiratory examination and you have checked "normal by inspection." What does that mean? A. Looking at him, there was, he was breathing normally, there was no abnormalities to his chest wall movements. Q. You checked "normal for palpation." What did you do to determine that? A. Felt both sides of his rib cage to feel for rib fractures; pressed on his sternum for any sternal tenderness to signify he hit the steering wheel. There was no external signs, bruises or anything on his chest. Q. You checked off normal by percusison and auscultation. Could you just briefly tell me for the record how did you that? A. Take a listen to breath sounds bilaterally to make sure. Q. You found out that he had no rales, no ronchi, no wheeze, no change in breath sounds at the time you did that? A. Yes. Q. At the time you were performing this evaluation, you were considering aside from a head injury, a chest injury as well. A. Yes. Q. So far on the basis of your examination, you found no outward evidence of that occurring, is that correct? A. Yes. Q. You next did a cardiovascular examination? A. Yes. Q. The heart you have checked off by inspection was normal. How did you do that? A. That would again be inspection of the chest wall itself. Q. By eyeballing it? A. Yes. Q. By palpation, there is no check mark. What kind of palpation would you have done? A. That is done in a--I did not. I typically don't do that in trauma. That's done in a very detailed physical exam. Q. There is no check mark for heart percussion. Does that mean you did not do any percussion? A. I did not. Q. You did no auscultation? A. Right.