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.