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Elaina: Emergency 2 > ED 2 Abuse > Flashcards

ED 2 Abuse Flashcards

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1
Q

what percent of women in the US report experiencing violence at some point in their lives?

A

25 percent

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2
Q

women who experience domestic violence are at an increased risk for what four diseases?

A

stroke, heart disease, alcoholism, asthma

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3
Q

as medical providers, when should we screen for abuse?

A

at EVERY visit PRIVATELY

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4
Q

your patient doesn’t want to report his/her abusive partner, what do we do?

A

respect their choices, document well (WRITTEN is better)

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5
Q

what is felt to be the best predictor of future homicide victims?

A

strangulation

50 percent of homicide victims have experienced at least 1 strangulation attempt

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6
Q

do people perform strangulation MC by ligature, manual, or hanging?

A

manual 80 percent of the time

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7
Q

how long until victim loses unconsciousness when 11 pounds of pressure are applied to the carotids?

A

10 seconds

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8
Q

when does permanent brain damage occur when 4.4 lbs of pressure are put on the jugular? how long until death?

A

permanent brain damage in 3 minutes

death in 4-5 minutes

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9
Q

how many pounds of pressure are required to occlude and fracture the cartilage of the trachea?

A

33 lbs

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10
Q

what are some symptoms of strangulation in your patient?

A

voice changes (50 percent)
painful swallowing
mental status change
loss of bowel/bladder control

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11
Q

what will you see on PE that will clue you into strangulation? what must you keep in mind?

A

petechiae (face, eyes, eyelids)

bruising of neck

only half of victims will have PE findings

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12
Q

what complications of strangulation will we worry about down the road?

A

delayed death due to carotid dissection or stroke

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13
Q

if your strangulation victim presents with petechiae and mental status change, what imaging should you order?

A

CTA of the neck

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14
Q

what percentage of sexual assaults are not reported to the police?

A

66 percent

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15
Q

a sexual assault victim presents to the ED and wants to go through with examination. which two specialists should you call to be a part of your workup? what do they do?

A

SAFE = aid in forensic care and collection of evidence, testify in court

sexual assault advocate = can be present in ED and there for outpatient support and referrals

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16
Q

what two things should you NOT do during your initial evaluation of a sexual assault victim?

A

1) DON’T give food or fluids – can disrupt evidence

2) DON’T remove clothing or anything unless acutely medically necessary

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17
Q

what are YOUR roles as a PA while a SAFE is doing their job?

A

1) do limited medical history
2) treat any acute injury
3) assess SAFE in swab collectionand other medical portions
4) obtain UA sample for PG status
5) make safety plan
6) give meds for PPX

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18
Q

if a SAFE is not available, who works as a team to care for the patient, what will your job be?

A

nurse and ED provider

nurse gets history and does forensic medical exam and collection

we complete anogenital exam collections/swabs and provide medical treatment (PG and STI prophylaxis, symptom management)

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19
Q

NEVER LEAVE THE KIT

A

just thought i’d say that

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20
Q

what is the time frame allotted for collection of the forensic kit post assault in adults?

A

5 days

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21
Q

how long will the kit be held, should the patient have the collection done and choose to be anonymous?

A

90 days

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22
Q

what population should you NEVER do speculum exams or vaginal swabs in?

A

prepubescent females

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23
Q

what is the risk of pregnancy in younger women (19-26) with unprotected intercourse 1-2 days before ovulation?

A

50 percent

24
Q

immediate use of emergency postcoital contraception reduces PG risk to what percentage?

A

1-2 percent

25
Q

what are the pros and cons to using plan B post assault?

A

pros: more effective, less NV SE
cons: ineffective over 176 lbs

26
Q

what is the biggest pro to using ella as emergency contraception?

A

better effectiveness at 3-5 days post assault

27
Q

in terms of STD prophylaxis, should we test before we treat?

A

no, won’t change TX anyways. just treat

28
Q

what do we give as PPX to everyone post assault/

A

1) trichomonas: flagyl 2 gm PO
2) bacterial vaginosis: flagyl 2 gm PO
3) gonorrhea: ceftriaxone IM
4) chlamydia: azithyromycin PO

29
Q

your patient has known penetration with blood/bodily fluid contact. what do you do?

A

immunized patient: nothing further

unimmunized patient: heptavax first dose in ED, then at 1-2 months, then 4-6 months

30
Q

very high risk hep B exposures should consider what in addition to vaccine?

A

hep B immune globulin IM

31
Q

what is the risk of HIV transmission in receptive anal intercourse? how about penile-vaginal?

A

anal = .5 percent

penile-vaginal = .1 percent

KNOW: these rates may be higher in sexual assault due to violent nature

32
Q

HIV PPX treatment must be started how soon? what two drugs are given?

A

must start within 72 hours, give truvada and kaletra

33
Q

when should you consider HIV PPX?

A

KNOWN unprotected intercourse

KNOWN reception of seminal, vaginal, blood occurred

victim is WILLING to complete TX

34
Q

during evaluation and management of acute, life-threatening injuries, should you continue to try to preserve evidence?

A

yes, always!

35
Q

when should you follow up with HIV PPX patient?

A

3-5 days, draw labs again at 3 and 6 months

36
Q

what should you do in the acute (less than 72 hour) setting of pediatric sexual assault? what about in the non-acute (over 72 hour) setting?

A

less than 72 hours: call SAFE for forensic exam (3 days for kids!)

non-acute: consult spurwink, do medical history/screening exam/documentation – mandatory reporting to DHHS

37
Q

if the child victim of sexual abuse is too scared or developmentally unstable to answer your questions, what should you do?

A

do not question the child, do not do repeated interviews

38
Q

what maneuver provides all the visualization needed for inspect of female victim of sexual assault?

A

labial tractions

39
Q

which 3 genital exams are NOT indicated in child victims of sexual assault?

A

1) speculum (not on prepubescent)
2) digital rectal exam
3) vaginal exam

40
Q

forensic evidence collection is rarely helpful after ____ hours in child sexual abuse cases

A

24 hours

contact spurwink

41
Q

is it okay to photograph/film injuries on children?

A

YES

42
Q

is STD prophylaxis used in pre-pubescent children?

A

NO

yes once they hit puberty

43
Q

when should PG testing and PPX be offered to female child victims of sexual assault?

A

tanner stage 2 or higher (from the first pubic hair)

don’t wait till first period!

44
Q

what are some risk factors in the CHILD to consider that could lead to child abuse?

A 
low birthweight
mental/physical health disability
excessive crying/colicky
frequent tantrums
twins/multiple gestations
45
Q

can a parent decline your request to perform a full head to toe assessment in a child should you suspect abuse?

A

nope!

46
Q

what 3 components should ALWAYS be included in your PE in a child who you suspect abuse in?

A

1) fundoscopic exam (retinal hemorrhages)
2) intraoral exam (petechiae)
3) anogenital exam

47
Q

what will accidental vs. non-accidental bruising look like in a child?

A

accidental = brusing on front of body, over bony prominences, extremities, forehead

non-accidental: trunk, ear, neck, cheeks, buttocks (likely symmetric)

48
Q

you see a big bruise on the 4 month old you are examining for a well-child check. is this normal?

A

NO

infants don’t bruise; less than 0.6 percent of infants less than 6 months bruise

49
Q

what should be a part of your workup for a child that presents with frequent bruising?

A

coagulation studies, CBC – rule out clotting/platelet disorders

50
Q

accidental bruises vs. non-accidental bruises on children?

A

accidental = asymmetric, irregular borders on face, neck, upper torso, palms, fingers

non-accidental: immersion patterns, sharp demarcation

51
Q

what percentage of abusive fractures are seen in children under 18 months?

A

85 percent

52
Q

you should ALWAYS suspect abuse in a non-ambulatory child under what circumstances?

A

fracture to humerus, femur, or rib

do full skeletal survey x-ray

53
Q

a child with many fractures should be considered for abuse, but what should you also do?

A

consider osteogenesis imperfecta

54
Q

what 7 incidences MUST you report to DHHS in any child under 6 months?

A

1) fracture
2) bruising
3) subdural hematoma
4) burns
5) poisoning
6) substantial bleed, impaired organ
7) any confirmed child abuse case

55
Q

what mnemonic do we use for attempting to put a stop to elder abuse?

A 
RADAR!
R = routinely ask about abuse
A = ask questions in private
D = document findings
A = assess for safety
R = resources and review options
56
Q

who do you report suspected elder abuse to?

A

adult protective services, DHHS

57
Q

who do you report confirmed elder abuse to?

A

adult protective services, DHHS, local law enforcement, safety planning

Elaina: Emergency 2 (11 decks)

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