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.
- Admissions for observation are a prudent procedure for patients presenting 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
- ED clinic 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.