Common Pitfalls  (MPS / MDU site)
AREA 1 is the head and the ED Officer's 'nightmare', ie. the patient who is brought to the Emergency Department either unconscious or exhibiting a reduced level of consciousness.     The 5 D's" should immediately spring to your mind
Drunk   Drunk and Dying (head inj)   Diabetes   Drug overdose   Disease (eg CVA)
AREA 2 refers to the intra-ocular foreign body. 
  • Any history of a sharp, small FB(s) impinging upon the eye with velocity  - A radiograph of the orbit is mandatory.  

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AREA 3 refers to multiple rib fractures: 
  • Consider an intra-thoracic organ injury which has not declared its presence at the time of the examination in the ED. 
  • Admissions for observation are a prudent procedure for patients presenting with multiple rib fractures.

AREAS 4, 5 and 11 refers respectively to the supra-condylar/other serious fracture in the elbow of children, fracture of both forearm bones and moderate to severe fractures of the tibia. 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.

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AREA 6 indicates the site of the Colle's fracture and fracture of the scaphoid bones. 

  • 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

    • ED clinic 10 - 14 days time

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AREA 7 refers to the hand. Three situations commonly reported to The Society are 

  • the deep foreign body

  • the divided tendon, and nerve

  • the unstable fracture or dislocation of the metacarpal or phalanx

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AREA 8 refers to the abdomen and the delay in the appearance of physical signs of injury to an organ following trauma to the abdomen. 

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

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AREA 9 refers to the failure to diagnose fracture of the hip following trauma. 

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AREA 10 refers to the knee joint.
  • Junior staff can underestimate the degree of traumatic damage to knee structures
  • Remember to check the popliteal and distal pulses

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AREA 12 refers to the ankle joint

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

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Content by Dr Íomhar O' Sullivan.   Reviewed by Dr ÍOS 02/03/2004, 19/05/2005. Next review 19/05/2006.