Acute CARE Flashcards
What are the most common signs of domestic violence?
Contusions, lacerations, fractures, abrasions - multiple locations
What are 5 key fractures seen in domestic abuse
Metaphysical fracture
sternal fracture
Rib fracture
Outer third clavicle fracture
Scapula fracture
What locations are likely domestic abuse locations
Face neck extremities and back usually
What are the steps of rehab process
Specialist consultant in charge and MDT team coordinate patient analysis/assessment, immediate treatment and management plan
Referred immediately to physiotehrpasit for assessment and movement
OT. For home changes, social worker for support and geriatricians for elderley likely to be invovled in care
5 impacts trauma can have on a patietn
- Depending on the trauma could be life limiting/changing
- Sick role adopted
- Off work - loss of independence
- Lean on close family and friends for support (character role swap)
- Stress andd concern about long term impacts
What are signs of non-accidental injuries
- Delayed presentation to the doctor
- A non-care/family member has brought them
- History doesnt match clinical findings
- Failure to have a complete and compatible history
- Associated injuries of perceived domestic abuse
- Other injuries that could indicate forcefulness or abuse
6 ways to health promote about burns and scalds
Fire alarm tests
PAT tests
Close doors when sleeping
Fire safety drills and regulations
Fire safety training
Charity
When are burns looking like a non-accident
No splashmarks are visible
Usually reinforcinng behaviour is clear on clinical findings
Lack of parental care
Signs of sparing of flexion creases (being in foetal position)
Who are at most risk of burns
- Under 5 year olds (50% happen in kitchen 45% of burns are children
- Diabetic neuropathy patients
- > 75s
Who are risk of suicide?
- Males
- Elderley
- Immigrant and refugees
- Prisoners
- Students
- Low socioeconomic class
- Low education
- Doctors
- Lack of social support
What are clinical causes of suicide?
- Previous mental health
- Specific illness with high rates of suicide or terminal illness
- Recent post-discharge
- Previous suicide
What are risk factors of a suicide attempt
- Severity of suicide attempt
- Plans to do it again
- No remorse/ regrets
- Done it before
- Want to do it again/intention
- Waiting to be alone
Protective factors against suicide
- Family and friends - children
- Cultural or religious beliefs
- Coping and problem solving skills
- Interacting with mental health services
What professionals are involved in mental health sectioning.
Section 12 doctor
AMHP (approved mental health professional)
Doctor known by patietn
Section 2?
Allows for compulsory admission to hospitals for assessment, diagnosis and treatment for 28 days.
- GP/known doctor, section 12 doctor needs to approve
- family relative or AMHP needs to make application for section 2
Section 4?
Emergency section, doctor to detain patient for 72 hours to assess/diagnose but not treat no application needed
signed by a doctor and either a AMHP/relative
Section 5(2)
Doctor can detain patient whilst waiting on someone to assess diagnose for 72 hours
Section 5(4)?
Nurse holding powers, nurse can detain for 6 hours waiting for approved psychiatrist
Who is an AMHP?
Social worker, nurses, OTs and psychologists
What 2 types of clinical reasoning are there
Type 1 type 2
what is type 2 clinical reasoning?
hypothetical-deductive reasoning. Make logical diagnoses but use follow up tests and scans to rule out other potential disease that could be more life threatening or severe
What is type 1 clinical reasoning/
Quick more fast process reasoning. Uses knowledge, experience and pattern recognition to assume a diagnosis and treat for it accordingly
what are some draw backs of type 1 clinical reasoning
- overconfidence may mean other serious diseases are overlooked
- not reliable source of reasoning due to no evidence
- flawed judgement can lead to omissions
- faults can be made more likely
what are some draw backs of type 2 reasoning?
- longer route, patient neeeds to be capable of waiting (not an emergency)
- patient needs to understand the different diseases and purposes of going to the scans and checks
- doctor needs to be willing to put time and effort in
- more robust as based off evidence
What are other names for type 1 and type 2 clinical reasoning?
Type 1 - intuitive
Type 2 - rational
What are the levels of care in hospital?
4 - 1:1 nursing care, 2 or more organ systems failing, almost always on ventilators
3 - 2:1 nursing care, HDU picture, just off ventilators, invasive monitoring still happening
2 - 4:1 nursing care, AMU picture, potential risk of condition decline, less invasive monitoring
1 - 8:1 nursing care, ward picture, routine bloods and treatment being given (IV, NG Feed etc.)
What is ceilings of care?
The maximum level of treatment method deemed appropriate for the patient, may not be given but set out in a plan for steps to be put into place based on shared decision making and family/friends of patient
How is ceilings of care assisted?
RESPECT form
What factors contribute towards ceilings of care?
- Patient requests
- Family requests
- Patients condition
- Anticipated outcome for the patient
- Acceptance and environmental factors (can they go to HDU?)
What is DNACPR
Do not attempt CPR
- used when CPR is not beneficial to the patient found on RESPECT form
When is DNACPR used?
- Patient too elderly risks of CPR worse than benefits
- Outcome of good CPR is low, let patietn die a dignified none ruthless death
- Patient refusal prior
What is a respect form?
Recommended summary of treatment plan for patietn if they may potentially lose capacity or at risk of rapid decline in health. Contains DNACPR and advanced wishes etc.
what are 2 types of risk assessment tools ?
- Risk scores (ASA, higher = worse outcome)
- Risk prediction models (POSSOM)
What is the most leading cause od death in children and young adults?
Traumatic brain injury.
Leading cause of TBI?
- Falls
- Motor vehicles
- Struck by/against
- Assaults
- Sports related injuries
- Others
