special pops Flashcards
coroner is called if
dead in the field or hospital if
suspicious or unnatural
do not call unless you have a license
the role of the ED is
evidence detection evidence preservation evidence collection documentation preserve the chain of custody and cooperate with law enforcement
avoid any comment that is subjective
SART stands for
sexual assault response team
includes SANE
non physician forensic examiners
DA’s office
police
crime lab
familiarity with local crime patterns
SANE stands for
sexual assault nurse examiners
what happens in a sexual assault exam
STABALIZE
need to determine which jurisdiction did this happen
the police of this jurisdiction need to handle the case
advocate is with the patient
California 923 form -state protocol
evidence collection: swabs, hair, vaginal secretions
colposcopy, toulidine blue
Screening and prophylaxis for STI and pregnancy
toluidine blue is for
looking at fresh abrasions in areas of redundencu
adheres to the nuclei of injured cells
prophylactic medications
treat for gonorrhea and chlamydia prophylactically
pregnancy prophylaxis
NOT HIV prophylaxis
HIV prophylaxis
need a very high viral loud
and a low T cell count
in the presence of abrasions it is higher but it is very unlikely that this would be the case
HOWEVER anal penetration with ejaculation is much higher especially if their are lesions at the anus
colposcopy
binocular magnifying device that allows for photographs of genitalia
two most common sites of vaginal abrasions
posterior frouchette
fossa navicularis
management of anal rape
colposcopy and anoscopy to look for and document injury
absence of vaginal injury is
common 50% will be seen with no genital injury
cold hits
national DNA database that allows for connection to perpetrators
SAFE
safety
afraid
friends/family
emergency plan
prepared for a pt who does not wish to report or accept resources
lethality index -high risk for homicide
choking gun in home threat to kill themselves alcohol or drug use sexual assault
sexual assault+ choking+stalking
edler abuse signs
injury does not match bruises or injury Weight loss Dehydration Depression Decubitus ulcerations Poor hygiene Medical “noncompliance” --> why are they not coming to the hospital Missed appointments, etc “Dropped off” at ED – no one available
APS should be contacted (adult protective services)
common cardio issues in adutls with DS
Congenital heart dz, great vessels
CAD common as get older
infection in DS
pylo occult skin as well as
Skin (MRSA), otitis media, dental, UTI/pyelo,
injuries that can be common to adults with DS
self-inflicted (often d/t anxiety), abuse, neglect
Osteopenia common: fx
Pica, Foreign Bodies, bezoars
endocrine in adults with DS
Diabetes, hypothyroidism
Vitamin deficiency
psych issues in adults wtih DS
Agitation – consider acute delirium
neuro issues in adults with DS
Seizures very common
Delirium more common
Hearing loss, vision loss (cataracts)
***Atlantoaxial instability (Down’s)
GI issues in adults with DS
Esophagitis, PUD
Constipation, fissures, impaction
Appy, volvulous, perf, etc…all harder to diagnose
abuse in adults with DS
DV sexual assualt x3 higher than average populations
neglect, and poor support
define FTT
pts who cannot adequately care for themselves in their current state of situation
inadequate care or resources
most of the time pts that have FTT to present because of
Overwhelming medical condition (For example – they faint at walgreens)
Sudden deterioration or delirium? Work it up
ED workup for homeless patient
vitals d-stick pregnancy test alcohol utox assess suicide risk psych issues worry about alcohol withdrawl feed the pt
big issue with quad/paraplegic pts and fever
Urinary tract infections – most common***
infected pressure sores, osteomyelitis
Pna, GI issues, perf, obstruction
UTI in plegia think
self-catheter or indwelling catheter
huge risk for UTI/pyelo-change catheter, culture
silent sxs hydronephrosis
injected pressure sores in pt with plegia worry about
chronic osteomyelitis
need to inspect all would care
always worry about this in wheelchair pt
DVT and PE risk from immobility
symptoms are silent!
IVDU pain threshold
lower
and tolerance–> may need more pain medications
overdose-narcan
when can you discharge a patient that is withdrawing
60-90 minutes after narcan can discharge
when can you give methadone
only for admitted patient
when would you give suboxone
if they are ready to quit today and withdrawing
IVDU with a fever worry about
endocarditis epidural abscess PNA dyspnea abscess wound botulism cotton fever
endocarditis in IVDU think…
Staph Aureus 50%, tricuspid valve 40%
back pain w/ weakness & IVDU get what
back pain w/ weakness & IVDU: emergent MRI
—>Epidural abscess
PNA IVDU worry about
often atypical organisms, TB
abscess in IVDU worry about
fever is worrisome – necrotizing fasciitis
dyspnea in IVDU worry about
Dyspnea? Think septic pulmonary emboli - CXR
wound botulism in IVDU would look like
descending weakness, ptosis, weak voice, DTR’s intact
what is cotton fever
rapid onset flu-like sx’s, benign, resolves 24hrs
did they filter their heroin with cotton
pocket shooters worry about
pneumothorax if miss
if needle breaks off XRAY!
heroin withdrawal will look like what
N/V, diarrhea, chills, malaise - miserable
tx heroin withdrawal with
Tx with Benzo’s, IV fluids for dehydration
EDs role with prisoners
medical clearance for jail arrest
injuries sustained during crime or arrest
forensic evidence -alcohol level
incarcerated pts with serious medical issues
biggest issue with prisoner pts
confidentiality !
special issues for pts in prisons
Traumatic injuries
Substance abuse in prison
Sexual assault
Psych issues
Manipulative behavior, fictitious illness (blood in urine – men can cut their own penis)
Foreign body ingestion
breach of security issue with prisoner patients
Inmate cannot know appointment date/time
must be fit for incarnations
