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Emergency Medicine > special pops > Flashcards

special pops Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

coroner is called if

A

dead in the field or hospital if
suspicious or unnatural

do not call unless you have a license

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2
Q

the role of the ED is

A 
evidence detection 
evidence preservation 
evidence collection
documentation
preserve the chain of custody 
and cooperate with law enforcement

avoid any comment that is subjective

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3
Q

SART stands for

A

sexual assault response team

includes SANE

non physician forensic examiners

DA’s office

police

crime lab

familiarity with local crime patterns

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4
Q

SANE stands for

A

sexual assault nurse examiners

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5
Q

what happens in a sexual assault exam

A

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

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6
Q

toluidine blue is for

A

looking at fresh abrasions in areas of redundencu

adheres to the nuclei of injured cells

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7
Q

prophylactic medications

A

treat for gonorrhea and chlamydia prophylactically

pregnancy prophylaxis

NOT HIV prophylaxis

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8
Q

HIV prophylaxis

A

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

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9
Q

colposcopy

A

binocular magnifying device that allows for photographs of genitalia

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10
Q

two most common sites of vaginal abrasions

A

posterior frouchette

fossa navicularis

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11
Q

management of anal rape

A

colposcopy and anoscopy to look for and document injury

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12
Q

absence of vaginal injury is

A

common 50% will be seen with no genital injury

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13
Q

cold hits

A

national DNA database that allows for connection to perpetrators

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14
Q

SAFE

A

safety
afraid
friends/family
emergency plan

prepared for a pt who does not wish to report or accept resources

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15
Q

lethality index -high risk for homicide

A 
choking
gun in home 
threat to kill themselves
alcohol or drug use
sexual assault

sexual assault+ choking+stalking

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16
Q

edler abuse signs

A 
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)

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17
Q

common cardio issues in adutls with DS

A

Congenital heart dz, great vessels

CAD common as get older

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18
Q

infection in DS

A

pylo occult skin as well as

Skin (MRSA), otitis media, dental, UTI/pyelo,

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19
Q

injuries that can be common to adults with DS

A

self-inflicted (often d/t anxiety), abuse, neglect
Osteopenia common: fx
Pica, Foreign Bodies, bezoars

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20
Q

endocrine in adults with DS

A

Diabetes, hypothyroidism

Vitamin deficiency

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21
Q

psych issues in adults wtih DS

A

Agitation – consider acute delirium

22
Q

neuro issues in adults with DS

A

Seizures very common
Delirium more common
Hearing loss, vision loss (cataracts)
***Atlantoaxial instability (Down’s)

23
Q

GI issues in adults with DS

A

Esophagitis, PUD
Constipation, fissures, impaction
Appy, volvulous, perf, etc…all harder to diagnose

24
Q

abuse in adults with DS

A

DV sexual assualt x3 higher than average populations

neglect, and poor support

25
Q

define FTT

A

pts who cannot adequately care for themselves in their current state of situation

inadequate care or resources

26
Q

most of the time pts that have FTT to present because of

A

Overwhelming medical condition (For example – they faint at walgreens)
Sudden deterioration or delirium? Work it up

27
Q

ED workup for homeless patient

A 
vitals
d-stick
pregnancy test 
alcohol 
utox
assess suicide risk
psych issues
worry about alcohol withdrawl
feed the pt
28
Q

big issue with quad/paraplegic pts and fever

A

Urinary tract infections – most common***

infected pressure sores, osteomyelitis

Pna, GI issues, perf, obstruction

29
Q

UTI in plegia think

A

self-catheter or indwelling catheter

huge risk for UTI/pyelo-change catheter, culture

silent sxs hydronephrosis

30
Q

injected pressure sores in pt with plegia worry about

A

chronic osteomyelitis

need to inspect all would care

31
Q

always worry about this in wheelchair pt

A

DVT and PE risk from immobility

symptoms are silent!

32
Q

IVDU pain threshold

A

lower

and tolerance–> may need more pain medications

overdose-narcan

33
Q

when can you discharge a patient that is withdrawing

A

60-90 minutes after narcan can discharge

34
Q

when can you give methadone

A

only for admitted patient

35
Q

when would you give suboxone

A

if they are ready to quit today and withdrawing

36
Q

IVDU with a fever worry about

A 
endocarditis
epidural abscess 
PNA
dyspnea
abscess
wound botulism 
cotton fever
37
Q

endocarditis in IVDU think…

A

Staph Aureus 50%, tricuspid valve 40%

38
Q

back pain w/ weakness & IVDU get what

A

back pain w/ weakness & IVDU: emergent MRI

—>Epidural abscess

39
Q

PNA IVDU worry about

A

often atypical organisms, TB

40
Q

abscess in IVDU worry about

A

fever is worrisome – necrotizing fasciitis

41
Q

dyspnea in IVDU worry about

A

Dyspnea? Think septic pulmonary emboli - CXR

42
Q

wound botulism in IVDU would look like

A

descending weakness, ptosis, weak voice, DTR’s intact

43
Q

what is cotton fever

A

rapid onset flu-like sx’s, benign, resolves 24hrs

did they filter their heroin with cotton

44
Q

pocket shooters worry about

A

pneumothorax if miss

if needle breaks off XRAY!

45
Q

heroin withdrawal will look like what

A

N/V, diarrhea, chills, malaise - miserable

46
Q

tx heroin withdrawal with

A

Tx with Benzo’s, IV fluids for dehydration

47
Q

EDs role with prisoners

A

medical clearance for jail arrest

injuries sustained during crime or arrest

forensic evidence -alcohol level

incarcerated pts with serious medical issues

48
Q

biggest issue with prisoner pts

A

confidentiality !

49
Q

special issues for pts in prisons

A

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

50
Q

breach of security issue with prisoner patients

A

Inmate cannot know appointment date/time

must be fit for incarnations

Emergency Medicine (28 decks)

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