Common Pitfalls  (MPS / MDU site)

Area 1: Head Injury

Head Injury is EM doctor's 'nightmare', ie. the patient who is brought to the Emergency Department either unconscious or exhibiting a reduced level of consciousness. Remember the 5 "d"s

Drunk, Drunk and dying (head injury), Diabetes, Drug overdose, Disease (.e.g. CVA)

Area 2: Eyes (Intra ocular FB)

Any history of a sharp, small FB(s) impinging upon the eye with velocity - A radiograph of the orbit is mandatory.

Area 3: Multiple rib fractures

  • Consider an intra-thoracic organ injury which has not declared its presence at the time of the examination in the ED
  • Admission (see Battle score at rib #s) may be prudent for those with multiple rib fractures

Area 4, 5 11 (fractures - supracondylar, elbow in children, tibial in adults

No patient should have pain from a limb in plaster

If he has, he must be seen quickly and his limb carefully examined, if necessary with the plaster removed.

"Area 6: "Wrist" fractures

Most allegations of negligence in the treatment of Colle's fracture refer to the failure to take fresh radiographs to ensure that the post-reduction position of the fracture has been maintained some 10 days later.

If, on clinical grounds, you suspect a fracture of the scaphoid:

  • scaphoid X-ray films must be requested (not "wrist" views)
  • even if the scaphoid X-ray films are "normal", immobilise in a futura splint and arrange follow up
  • ANP review 10 - 14 days time

Area 7: Hand Injuries

  • Deep foreign body
  • Divided tendon, and nerve
  • Unstable fracture or dislocation of the metacarpal or phalanx

Area 8: Abdominal trauma

  • Consider admitting the patient for observation where the history elicited suggests the possibility of an intra-abdominal injury

Area 9: Failure to Dx NOF # after fall

Area 10: Knee joint

  • Don't underestimate the degree of traumatic damage to knee structures
  • Remember to check the popliteal and distal pulses

Area 12: Ankle joint

  • Please record "Ottawa Rules" status in all presenting with ankle injuries

Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 11/04/23.