History Stations Flashcards
Back Pain
2022.1 Station
Take a focussed history
Interpret examination findings given
List differential diagnoses
Outline investigations with justification
DIFFERENTIAL DIAGNOSIS:
Intervertebral disc prolapse
Degenerative arthritis
Spinal stenosis
Inflammatory:
- Transverse myelitis
- Ankylosing spondylitis
- Rheumatoid arthritis
Infection:
- discitis
- osteomyelitis
- epidural abscess
Congenital:
- kyphosis
- scoliosis
Haematological:
- sickle cell crisis
- bleeding tendency causing epidural haematoma
Malignancy - spinal tumour
Vertebral fracture:
- pathological
- traumatic
Vascular:
- spinal cord infarction
Referred pain from abdominal pathology:
- AAA
- Renal colic
- UTI/pyelonephritis
- Prostatitis
- Pancreatitis
- Mesenteric ischemia
- PID
- Endometriosis
Referred pain from hips/pelvis
- arthritis
- occult fracture
RED FLAGS:
- pain worse at night lying supine
- fevers, weight loss, night sweats
- malignancy
- current infections (cellulitis, pneumoniae, UTI) homogenous spread
- immunesuppression (diabetes, HIV, transplant)
- immune suppression medication
- IVDU
- trauma
- chronic corticosteroids
- osteoporosis
- inflammatory arthritis
- saddle anaesthesia
- weakness, numbness or tingling in legs
- bowel or bladder dysfunction
YELLOW FLAGS:
- Belief that pain and activity are harmful
- Sickness behaviours
- Low or negative moods, mental illness
- Treatment that does not fit with best practice
- Problems with compensation system
- Previous history of back pain with time off work
- Problems at work, poor job satisfaction
- Overprotective family or lack of social support
History:
“can you tell me about the issues you’ve been experiencing”
Site -
Onset -
Character -
Radiation -
Alleviating & Aggrevating factors (worse pain at night and lying down)
Progression -
Response to analgesia -
Key Symptoms:
- numbness, tingling or weakness
- urinary incontinence or retention
- bowel incontinence or constipation
- fever
- infections (cellulitis, UTI, LRTI’s)
- constitutional symptoms (lethargy, weight loss, night sweats)
- trauma or injury
- malignancy
- previous spinal surgery
- IVDU
- medications - prolonged steroid use, analgesia, anticoagulation
- family history of arthritis (ankylosing spondylitis)
- impact on employment and daily activities
Dysuria (pyelonephritis, UTI)
AAA
Pain relief and pain management strategies
PMHX:
*Malignancy
*Osteoporosis
*Inflammatory arthritis - ankylosing spondylitis
*Bleeding disorder - epidural haematoma
*Clotting disorder - spinal infarction
*AAA
MEDICATIONS:
*chronic steroids - osteoporosis & immune compromise
*anticoagulation - epidural haematoma
*Immune suppression - azathioprine
SOCIAL:
*work - problems at work, sick days, poor job satifaction
*activities of daily living
*mental health - depression, suicidal ideation
*social supports
*IVDU
*alcohol
*smoking
COUNSELLING:
Back pain is very common
Only a very small proportion have a serious diagnosis
pain and activity is not harmful to your spine
*not for imaging in ED - cause harm
Radiation exposure:
- Xrays lumbar spine - equivalent to having 100 chest xrays
- CT lumbar spine - equivalent to having 500 chest xrays
- Overdiagnosis
*Trial analgesia and physiotherapy and if ongoing pain can discuss with GP about having an outpatient MRI
Non-pharmacological:
- get up and get moving
- physiotherapy referral - tailored exercise plan
- massage
Psychologist referral
Pharmacological:
- paracetamol 1g QID
- short course NSAID ibuprofen 400mg TDS (commence PPI)
- short course of oxycodone (advise prn, highly addictive, don’t mix with alcohol, cannot operate heavy machinery)
*Patients with spinal stenosis or disc prolapse with severe radicular pain may hand inpatient CT guided injections (lumber and sacral nerve root and facet joint injections)
Back Pain
2023.2 History taking station
take a history from a patient with back pain and to discuss the case further with the examiner.
Take a focused history from the patient.
- Interpret examination findings provided by the examiner and prioritise your differential
diagnoses.
- Describe and justify further investigations for the patient
IMAGING:
CT Lumbar spine:
- if suspect vertebral fractures in major trauma
- MRI is contraindicated
Xray Lumbar spine:
- suspect vertebral fracture with no trauma (osteoporosis)
MRI:
- gold standard
- very little radiation
Neck Pain
2023.1 History taking
Take a history from a patient presenting with neck pain.
List differential diagnosis
Intervertebral disc prolapse
Degenerative arthritis
Spinal stenosis
Inflammatory:
- Transverse myelitis
- Ankylosing spondylitis
- Rheumatoid arthritis
Infection:
- discitis
- osteomyelitis
- epidural abscess
Congenital:
- kyphosis
- scoliosis
Haematological:
- sickle cell crisis
- bleeding tendency causing epidural haematoma
Malignancy - spinal tumour
Vertebral fracture:
- pathological
- traumatic
Vascular:
- spinal cord infarction
Referred pain from head:
- SAH
- migraine
Referred pain from shoulder
- arthritis
- occult fracture
- dislocation
RED FLAGS:
- fevers, weight loss, night sweats
- pain worse at night
- neurological deficit
- syncope
- malignancy
- immunocompromise
- IVDU
- osteoporosis
- increasing age
HISTORY:
SOCRATES
Site
Onset
Character
Radiation
Aggravating or Alleviating factors
Timing
Excacerbating factors
Severity
Pain relief
Associated symptoms:
- weakness, numbness, parasthesia
Syncope on head turning
Headache
Trauma
History of cancer (metastatic disease)
Previous injuries or surgeries
Shoulder pain or injury (referred pain)
Constitutional symptoms:
- fever
- weight loss
- night sweats
Lymphadenopathy - infection/malignancy
IVDU - osteomyelitis
Sore throat
Difficulty swallowing
Choking on food or water
Stridor or difficulty breathing
PMHx:
Medications:
Allergies:
Social:
- work (affect daily living)
- IVDU
History taking Sexually Transmitted Infection
2022.1 station
Patient Education on Prevention:
- abstinence
- vaccination against Hep B and HPV
- reduce number of sexual partners
- mutual monogomy
- barrier protection with condoms
Encourage regular STI testing
Encourage your partner to undergo STI testing
Post Exposure Prophylaxis
2022.1 History Taking Station
PEP
HISTORY:
- when
- what (unprotected vaginal/anal)
- ulcers, skin tears, bleeding (increases transmission)
- source (HIV status, on PrEP, CD4 count)
- high risk source (men who have sex with men, uses IV drugs, comes from high prevalence area where the prevalence is higher than 1%)
- contraception and pregnancy
Time frame – Start within 72hrs of exposure (reduces risk of transmission by 80% if started within 72hrs)
Continue for 28days
Renal impairment – will determine which PEP regimen you receive
Pregnancy status - will determine which PEP regimen you receive (as some regimens are teratogenic with increased risk of neural tube defects) – should have pregnancy test
Should be on contraception during PEP treatment
Counselling
- Drug side effects – diarrhoea, rash, headache, fatigue, liver dysfunction
- Drug interactions (medication hx including over the counter medications)
- Education about safe sex
- PEP is not 100% effective in preventing HIV
- Counsel about HIV seroconversion symptoms – flu like illness, fever, sore throat, diarrhoea
Pre- testing counselling:
Investigations:
HIV antigen/antibody test)
- At baseline (before starting PEP)
- 1m, 3m and 6m after finishing
Hep C serology
Hep B serology (checking if immunised to Hep B, Hep B antibody positive)
STI screening - chlamydia, gonorrhoea, syphylis
PEP
Renal functions – will have different PEP regimen if renal function
Bhcg – will have different PEP if pregnant (some are teratogenic)
LFTs – at baseline, 2wks and 4wks - PEP can cause liver dysfunction
Risk of transmission:
HIV 0.3%
Hep B 23-27%
- Vaccinate Hep B immunoglobulin if not immune
- Offer emergency contraception
- Educate on safe sex practices (abstinence, barrier protection)
- Follow up with community sexual health - will need follow up testing
- Address contact tracing - directly or through contact tracing website “Let them know” “the drama down under”
- Immunisation against HPV, Hep A, Hep B
- PrEP for men who have sex with men
Emergency Contraception
2016 Counselling Station
19yr old girl presents to ED after for the emergency contraceptive pill 2 days after having unprotected sex. Triage comment that she seems anxious.
Take a focussed history.
What do you know about the emergency contraception pill? Have you read anything about it online perhaps?
When exactly?
Do you know the person well?
Was the sex consensual?
When was the first day of your last period?
Regular or irregular?
How long are your cycles?
What are you using for contraception?
Would you like to discuss options for ongoing contraception?
Do you have a stable partner?
Have you ever had a STI?
When was the last time you had a STI screen?
STI Symptoms:
- abnormal vaginal discharge
- lumps or bumps
- ulcers
- pelvic pain
- abnormal vaginal bleeding
- pain during intercourse
Weight is important for ECP selection
Medications - ECP interacts with drugs that induce liver enzymes
Ulipristal 30mg PO stat within 120hrs (5 days)
- more effective than levonorgestrel. inhibits ovulation despite LH surge.
- interacts with drugs that induce liver enzymes rendering it less effective therefore should not be used
- less effective if BMI>30 or weight >85kg, cannot double the dose
- can cause nausea and vomiting, if vomit within 3hrs, a repeat dose is needed
Levonorgestrel 1.5mg PO stat within 96hrs (4 days)
- delays or inhibits ovulation
- less effective if BMI >26 or weight >70kg, should double the dose in this situation
- interacts with medications that induce liver enzymes, therefore should double the dose in this situation
Copper IUD insertion within 5 days
- 99% effective
- prevents implantation
- can be used as ongoing contraception
- requires negative STI screening and trained physician to insert
Levonorgestrel and ulipristal can cause nausea and vomiting; the dose should be repeated with an antiemetic if vomiting occurs within 3 hours of the dose.
Follow up pregnancy if your next period is late or lighter than usual
Counselling The Angry Parent
EM Rapid Bombs ep 270 - acute otitis media
2022.1 Station
Paediatric patient seen in ED with ear ache discharged home with viral otitis media. Represents 5 days later with ear ache. Parent is angry that they were not given antibiotics during the first presentation.
Counsel the parent
Station Tips:
- Antibiotics are often inappropriately prescribed
- often viral, even if bacterial - often self limiting
- resolves spontaneously within 3-4 days
- bacterial causes (S. pneumoniae, H. influenzae, Moraxella catarrhalis)
- signs (bulging tympanic membrane, middle ear effusion, perforation with exudate)
Defend the management plan by the initial treating physician
EXPLORE parents ideas, concerns and expectations
- What do you know about ear infections and antibiotics?
- what would you say your main concerns are?
- what are your treatment goals and expectations from your visit to the ED today?
EMPATHY:
- I can imagine how difficult it is to see your child in pain and being unwell
- As a parent myself, I can understand your frustration
SUMMARISE:
- Ask them to summarise the main points to check their understanding
QUESTIONS?
- Ask if they have any questions
WRITTEN HANDOUT INFORMATION
- Give written information pamphlet
Communication (30%)
* Introduces self and purpose and attempts to establish rapport
* Establishes the concerns/issues/needs of the parent early in the encounter
* Demonstrates empathy and allows the parent to react emotionally to the situation
* Demonstrates a professional and respectful approach.
Medical Expertise: Management – (30%)
* Adapts and initiates standard therapies to that patient
* Describes treatments specific to the condition
* Outlines an overall plan for ongoing treatment of the patient
* Identifies risks of deterioration in the patient – complications of the condition.
Leadership and Management (40%)
* Listens respectfully
* Acknowledges the parent’s concerns
* Uses advanced communication techniques to defuse the anger/anxiety in the parent
* Outlines the immediate management plan to resolve the issue.
Candidates were required to meet with the parent and to:
* explain the current situation and the plan for the patient
* address their concerns about the presentations.
SHARED DECISION MAKING WITH THE PARENT:
EDUCATE:
- Acute otitis media is commonly a viral infection, but can be bacterial or have both a viral and bacterial cause.
- Regardless of the cause, it is usually self-limiting. Spontaneous resolution occurs in more than 80% of children within 2 to 3 days; symptoms may persist for up to 8 days in some children.
REASSURANCE:
- I want to reassure you that otitis media is a self limiting condition
- severe complications are rare
- Symptoms of otitis media will usually last for about 2 - 3 days with or without antibiotics
DISCUSS LIMITED BENEFITS
- there is limited benefits with antibiotic use, even when a bacterial cause is likely
- antibiotics do not improve pain at 24hrs
- for every 100 children treated with antibiotics, only 5 children will feel better at 3 days
- antibiotics only shorten the duration of illness by about 12hrs
- it is not possible to know in advance which children will benefit and which children will not
DISCUSS THE POTENTIAL HARMS OF ANTIBIOTIC USE:
- adverse reactions (diarrhoea, vomiting, rash and more serious hypersensitivity reactions)
- antibiotics disrupt the balance of bacteria in the body (the microbiome) which can lead to other infections such as thrush
- antibiotics can cause bacteria in the body to become more resistant so that future infections are harder to treat. Multidrug resistant bacteria or “superbugs” which is problematic for the entire community.
- for every 100 children treated with antibiotics, 7 children will experience an antibiotic adverse effect.
- it is not possible to know which children will experience adverse effects and which will not.
Drug interactions between antibiotics and regular medications
SIGNS OF ACUTE MASTOIDITIS:
- very rare but serious complication
- with ongoing otitis media, infection spreads to the the mastoid bone
- fever, red, hot, tender swelling behind the ear
- need to come to ED
OTHER COMPLICATIONS with chronic otitis media:
- meningitis
- brain abscesses
- lateral or sigmoid sinus thrombosis
MANAGEMENT:
Treat with pain relief - regular paracetamol and ibuprofen
Follow up in 2-3 days
Return to ED if symptoms worsen or no improvement in 2-3 days
A delayed prescription for antibiotics if the parent is unable to return for review
Written information about otitis media
Amoxycillin 30mg/kg PO BD 5 days
Bronchiolitis
2022.1 Station - Counselling parent about discharge home
Check parents understanding about bronchiolitis - “What do you know about bronchiolitis?”
Educate:
- bronchiolitis is a COMMON chest infection
- affects babies up to 12 months
- it is caused by a VIRUS
- the viral infections causes the airways to become inflamed and mucus to build up. This makes it more difficult to breath.
- babies usually are at peak sickness at day 2-3
- the illness usually lasts for 10days but a cough may persist for weeks
- need to avoid contact with other people in the first few days because the virus is contagious
- there are no medications or antibiotics that help treat bronchiolitis
- Babies need to rest and drink small amounts more often.
- saline nasal drops can help clear nasal passages to help feed more comfortably
- SMOKING! Ensure your baby is in a smoke-free environment.
RETURN ADVICE:
- difficulty breathing
- apnoeas (periods where they stop breathing)
- inability to feed
- change in colour
- parental concern
CHECK PARENTS UNDERSTANDING
- ask them to repeat the main points
ANY QUESTIONS
ANY CONCERNS or WORRIES
GIVE WRITTEN INFORMATION FOR PARENTS TO TAKE HOME
Consider HOSPITAL ADMISSION for HIGH RISK babies:
- Chronic lung disease
- Congenital heart disease
- Prematue
- < 8 weeks of age
- Growth restriction or failure to thrive
- INDIGENOUS
- down syndrome
SAFE FOR DISCHARGE HOME:
- safe discharge destination (reliable parents, proximity to medical services, have car and phone)
- no risk factors for deterioration
- adequate oxygenation SaO2>90% (not requiring oxygen or NIV)
- adequate feeding (not requiring NGT)
Headache in Pregnancy
2021.2 History taking station
- Take the history
- Relevant differential diagnoses
- Further investigation and management
Medical Expertise: History taking and differential diagnosis – 50%
* Seeks evidence of time critical diagnoses when performing assessment
* Generates a relevant list of differential diagnoses
* Elicits a focused, relevant history de novo
* Identifies important historical details (red flags) diagnostic of the conditions
Medical Expertise: Plan for further assessment – 20%
* Creates a focused investigation plan that confirms or excludes time critical diagnoses
* Explains the reasons for selecting those tests in that investigation plan
* States the theoretical accuracy of an investigation for confirming a diagnosis
Communication – 30%
* Introduces self and purpose, establishes rapport, demonstrates a professional and respectful
approach
* Uses appropriate non-verbal skills e.g. body language, space between doctor and patient, eye
contact
* Uses language appropriate to the patient’s level of understanding / avoids jargon/ explains
medical terms
* Actively listens e.g. paraphrases and clarifies what has been said
Wash hands
Introduce
Gain permission
Start with Open Ended Questions:
“What’s brought you in to the ED today?”
“Tell me about the issues you’ve been experiencing.”
“Ok, can you tell me more about that?”
“Can you explain what that pain was like?”
SOCRATES:
SITE:
“Where is the headache?”
“Can you point to where you experience the headache?”
ONSET:
“Did the headache come on suddenly or gradually?”
“When did the headache first start?”
“How long have you been experiencing the headache?”
thunderclap headache, reaching maximum intensity within 5 min = SAH
CHARACTER:
“How would you describe the headache?”
- ‘aching’, ‘throbbing’, ‘pounding’, ‘pulsating’, ‘pressure’, ‘pins and needles’ and ‘stabbing’.
RADIATION:
“Does the headache spread elsewhere?”
- neck (meningitis, SAH)
- face (trigeminal neuralgia)
- eyes (acute angle closure glaucoma)
ASSOCIATED SYMPTOMS:
“Are there any other symptoms that seem associated with the headache?”
TIME COURSE:
“How has the headache changed over time?”
“Is the headache worse at a particular time of day?”
EXACERBATING OR RELIEVING FACTORS:
“Does anything seem to trigger or make the headaches worse?”
“Does anything make the headaches better?”
Triggers - caffeine, excessive codeine use, stress, coughing, lying flat, physical exertion, sex
Relieving factors - analgesia
SEVERITY:
“On a scale of 0-10, how severe is the headache, if 0 is no pain and 10 is the worst pain you’ve ever experienced?”
KEY SYMPTOMS:
- Nausea & Vomiting
- Visual disturbance (flashing lights, reduced vision, blind spots, blurred vision)
- Photophobia
- Neck stiffness or pain
- Rash
- Fever
- Weakness, numbness, tingling in arms or legs
- Tender temples, tender scalp, pain in jaw with chewing (GCA)
RED FLAGS:
- thunderclap headache = pain at least 7/10 in less than 1min
- head trauma
- physical exertion
- fever, purpuric rash, neck stiffness
- altered mental status or LOC
- new focal neurological deficit
- seizure
- visual disturbance
- malignancy
- pregnancy
- connective tissue disorder (marfans, ehler danlos)
- anti-coagulation
- immune suppression
SYSTEMS REVIEW:
- Viral URTI symptoms (headache occurs in 60%)
- ENT pain suggestive of otitis media or sinusitis
PAST MEDICAL HISTORY:
- Hypertension
- Malignancy (Metastases)
- Connective tissue disorders (carotid/vertebral artery dissections)
- Thrombophilia (cerebral venous sinus thrombosis)
- Bleeding disorders
- Immune compromise (intracranial infections)
- Head trauma (bleeds)
- CSF shunt device (blocked or kinked)
FAMILY HISTORY:
- Aneurysms or sudden death
- Polycystic kidney disease
MEDICATIONS:
- Analgesics (analgesia overuse headache)
- nitrites
- Anticoagulation (bleeds)
- OCP (cerebral venous sinus thrombosis)
ALLERGIES:
SOCIAL:
- alcohol abuse (increases risk of ICH due to falls and liver dysfunction with prolong coagulation times and thrombocytopenia)
- drugs (cocaine, amphetamines increase risk of ICH and PRES)
- occupation (occupational exposure to carbon monoxide)
- stress (tension headache)
- affects daily living?
- Domestic violence (increased in pregnancy)
EXAMINATION:
General:
- Fever
- Hypertension
- Cough, coryza
- Photophobic
- Mental status/level of consciousness
Head/Neck:
- Meningism (Kernigs)
- ENT exam (otitis media/sinusitis)
- Palpate temples and scalp for tenderness (GCA)
EYES:
- Visual acuity
- Visual fields
- Pupils and eyelids for Horner’s syndrome
- measure IOP with tonometer
FUNDOSCOPY assess for papilloedema
- optic disc oedema with cotton wool spots
- optic cupping (optic disc ration of 0.8) - normal is 0.8
- spontaneous venous pulsations
POCUS - EYE
- 90% sensitive for detecting raised ICP
- no universal cut off level for the diameter of the optic sheath
- optic sheath diameter <5mm considered normal, >6mm is abnormal
- use linear probe
- lots of gel to avoid applying pressure to the eye ball
- can see bump that represents papilloedema
- measure diameter of optic sheath > 6mm
DIFFERENTIAL DIAGNOSIS OF HEADACHE IN PREGNANCY:
- Pre eclampsia
- Cerebral venous sinus thrombosis
- Posterior reversible encephalopathy syndrome
- Pituitary apoplexy
MIGRAINE:
- starts unilateral
- pulsatile/throbbing
- may have aura
- familiar triggers
- history of migraines with multiple previous episodes that feels similar
- nausea/vomiting
- photophobia/phonophobia
- lasts 4-72hrs
CLUSTER HEADACHE:
- severe (patient distressed or restless)
- unilateral
- lasts 15-180mins
Ispilateral symptoms:
- lacrimation
- eyelid swelling
- ptosis or miosis
- conjunctival injection
- nasal congestion
- sweating of forehead
Rx:
- 100% oxygen with 15L/min NRBM 20min
- sumatriptan 20mg IN or 6mg sc
TENSION HEADACHE:
MEDICATION OVERUSE HEADACHE:
- overuse of triptans/opioids leading to rebound headache
HYPERTENSION HEADACHE:
INTRACRANIAL HYPOTENSION:
- post LP or epidural
- worse when sitting upright or standing
- better when lying down
Rx epidural blood patch
IDIOPATHIC INTRACRANIAL HYPERTENSION:
- obese women aged 20-45yrs
- associated blurred vision and vision loss
- can lead to permanent vision loss if not treated
- papilloedema with opening pressures >25cmH2O
- LP in lateral decubitus position
- no sedation (hypercapnoea can give false reading)
- base of the manometer should be at the level of the right atrium
- tell patient to avoid valsalva
- opening pressures of >25cmH2O is diagnostic
- can removal 1ml aliquots of CSF (1ml of CSF removal will lower ICP by 1cmH2O - aim for 15-20cmH2O)
Rx oral acetazolamide 250mg bd
Ventricular Peritoneal Shunt
Optic nerve sheath fenestration
Weight loss
CAROTID/VERTEBRAL ARTERY DISSECTION:
SUBARACHNOID HAEMORRHAGE:
SUBDURAL HAEMORRHAGE:
INTRACEREBRAL HAEMORRHAGE:
MENINGITIS/ENCEPHALITIS:
CEREBRAL VENOUS SINUS THROMBOSIS:
POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME:
MALIGNANCY:
OCCIPITAL NEURALGIA:
- electric shocks and hypersensitivity in the distribution of the nerve
Rx occipital nerve block
GIANT CELL ARTERITIS:
ACUTE ANGLE CLOSURE GLAUCOMA
- decreased visual acuity
- fixed dilated pupil
- hazy cornea
- IOP > 30mmHg
CARBON MONOXIDE EXPOSURE:
- smoke inhalation
- engine exhaust
- heating sources with inadequate ventilation
PITUITARY APOPLEXY:
- spontaneous haemorrhage or infarction of the pituitary gland
- retro-orbital, bifrontal headache
- associated ophthalmoplegia, reduced visual acuity, visual field defects
THIRD VENTRICLE COLLOID CYST:
- intermittent obstruction of CSF drainage at the foramina of Monro causing sharp increases in ICP
VALSALVA HEADACHE
COITAL HEADACHE
INVESTIGATIONS for Pre-eclampsia
FBC/EUC/LFT/LDH
- low haemoglobin with haemolysis
- high LDH with haemolysis
- elevated liver enzymes (ALT & AST)
- low platelets
- high haematocrit
Headache with Vision Impairment
DIFFERENTIAL DIAGNOSIS
- Acute closure angle glaucoma
- Giant cell arteritis
- Idiopathic intracranial hypertension
- Pituitary apoplexy
- Migraine with aura
- Optic neuritis
- Herpes zoster ophthalmicus
- Stroke (ischemic & haemorrhagic)
- Orbital cellulitis
Domestic Violence
2021.1 History taking station
take a focused and relevant history from a patient (role player) who is a victim of domestic violence.
In addition to providing urgent medical attention, the safety of the patient and their children is paramount so referral to social work must occur.
Always ask about the safety of any children in the home; where the children are now and who is looking after them.
Follow mandatory reporter responsibilities in relation to any children that are at risk.
Reassure the patient that responsibility for violence always lies with the perpetrator; that domestic and family violence is a crime; and that they have a right to be safe, as do their children.
Document injuries in detail. Take measurements and photographs.
Make a referral to the Social Worker who will complete a psychosocial assessment and coordinate appropriate intervention.
If the situation presents out-of-hours, the hospital on-call Social Worker should be contacted. If this is not available at your service, the patient may require overnight admission to ensure adequate assessment is made in daylight hours.
Always be aware of a patient’s autonomy. This means that the choice to report domestic and family partner violence rests with the patient unless they have significant life threatening injuries or serious safety concerns.
Police should be contacted for serious injuries and serious safety concerns.
Serious injuries would include gunshot wounds, stab wounds, fractures, head or neck injuries including strangulation.
Serious safety concerns includes if perpetrator has access to a gun, carrying or using a weapon and is threatening to cause physical harm to any person including children.
Under the NSW Government’s Domestic and Family Violence Framework reforms (2014) it is strongly recommended that safety overrides patient confidentiality.
