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Emergency Med Final > special populations > Flashcards

special populations Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

forensic

A

pertaining to or belonging to the legal process

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2
Q

ED role in forensic cases

A 
evidence detection, preservation
evidence collection if appropriate
documentation
preserve "chain of custody"
cooperate/work w/ law enforcement
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3
Q

principles of forensics

A

observe state of injury- acute/old?
don’t miss, lose, destroy evidence
photos: police or by ED staff
avoid interpreting findings

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4
Q

how can you avoid missing, losing or destroying evidence

A 
thorough hx & exam
measure, describe injuries
don't throw evidence away or wash it off (clothing, debris, stains, FB's, etc)
do not alter the wound(s) if possible
describe exactly & only what you observe
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5
Q

wound ballistics

A 
tissue damage is related to:
range
velocity
caliber
type
fragmentation
deformity
*avoid calling entry/exit wounds
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6
Q

PA’s deal with what type of GSW’s?

A

extremities

*close range- gook for gunpowder, burns around site; look for clothing in wound, save clothes

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7
Q

GSW mgnt

A 
stabilize if unstable
determine where, how many, other injury
vascular integrity is the priority in extremities: pulses, pallor, cold distal?, sensory exam
x-ray all- if fx, can tx as closed fx
local wound care, debridemnet
surgery, other consult
consider Abx
splint, close f/u
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8
Q

knife/stab wounds

A

often defensive (we deal w/ extremities only)
good hx, police report
count, measure, explore
imbedded objects are removed in OR- don’t pull out
do not extend wounds if possible
repair/leave open for delayed primary closure in 3-5 days
x-ray all- fx, FB
consult surgery, ortho
consider Abx, close f/u

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9
Q

arterial bleeding of extremity

A

universal precautions
check for FB, elevate part
direct pressure 1st: 1 finger, gauze, pressure just proximal for 10 min; BP cuff as tourniquet (mark time)
pressure dressing- sub tightly rolled gauze for finger; layer larger on top, wrap

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10
Q

arterial injury testing: ABI

A

Ankle-Brachial Index (ABI)

  • comparison of ipsilateral UE & LE systolic pressure
  • pt supine, BP cuff, doppler
  • Doppler brachial SBP, then highest of dorsalis pedis & posterior tibial
  • ABI= ankle SBP/brachial SBP
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11
Q

arterial pressure index (API)

A
  • compare upper or lower extremities to each other
  • API=injured SBP/uninjured SBP
  • > 0.9 nml; if less = concern for vascular injury
  • duplex ULS, ateriogram if <0.9
  • pseudoaneurysm concern
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12
Q

what is normal for arterial pressure index?

A

> 0.9

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13
Q

forcible rape (Uniform Crime Reporting Program) old definition

A

carnal knowledge of a female w/o consent

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14
Q

forcible rape (Dec. 2011 definition)

A

penetration, no matter how slight, of the vagina or anus of any body part or object, or oral penetration by a sex organ by another person, w/o the consent of the victim

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15
Q

SART

A

sexual assault response team

  • provides consistency, expedites care
  • familiarity w/ local crime patterns
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16
Q

SANE

A

sexual assault nurse examiners

  • non-physician forensic examiners, esp. trained in this field- adults & CH
  • examine, collect & ctrl evidence & testify to findings
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17
Q

team approach w/ SART

A

examiner, social services/advocacy, police, DA’s office all collaberate

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18
Q

sexual assault exam

A

police, EMS or self- present
stabilize pt (stability trumps evidence-ALWAYS)
police jurisdiction (where it happened) must authorize evidence collection
advocate is w/ pt at all times
detailed hx of assault- CA 923 form
head to toe exam for injuries, forensic evidence
external genitalia, speculum & anal/rectal

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19
Q

evidence collection for sexual assault exam

A 
swabs
hair
vaginal secretions, etc
coloscopy
toluidine blue
photos
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20
Q

screening & prophylaxis in sexual assault

A

STD & UPT

HIV prophylaxis not routine

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21
Q

colposcopy & Toluidine blue

A

colposcopy for magnification

toluidine blue highlights disrupted mucosa

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22
Q

MC sites for injury in sexual assault

A

posterior fourchette & fossa navicularis

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23
Q

absence of genital injury is common

T/F

A

true

about 50% of sexual assault victims will not have genital injuries

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24
Q

sperm is found in about what % of survivors

A

10%

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25
Q

females often know assailant

T/F

A

85% of females DO know their assailant

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26
Q

the absence of genital injury does not imply what?

A

consent

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27
Q

absence of sperm does not imply that penetration?

A

did not occur

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28
Q

presence of sperm implies penetration took place- does not speak of ?

A

consent

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29
Q

after the assault: the “system” is improving

A

collaboration, training
national DNA data base- “cold hits”
qualified expert witness pool
sexually exploited minors project

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30
Q

sexual assault and effects on the survivor

A

PTSD common
missed work, disrupted lives
cost to society

31
Q

our role in domestic violence

A 
high index of suspicion
ID
acknowledge
inform 
report (mandatory in CA) 
refer
32
Q

domestic violence documentation

A

document injuries & hx using quotes & exact phrasing

*this is key

33
Q

red flags in domestic violence

A 
injury pattern-often ctrl
injuries of various ages
delayed presentation
inconsistent hx
partner's behavior (clingy)
pt's behavior
chronic complaints- HA, GI, pelvic pain
pregnancy
mental health issues
drug/alcohol abuse
34
Q

S.A.F.E questions

A

Safety/Stress
Afraid/Abused
Friends/Family
Emergency Plan

35
Q

Safety/stress?

A

Do you feel safe now? Stressors?

36
Q

Afraid/Abused?

A

Afraid now? Abused before

37
Q

Friends/Family

A

Do friends/family know

38
Q

Emergency Plan

A

Prepared &/or safe place to go

39
Q

recognizing child abuse

A

**injuries inconsistent w/ hx
**injuries inconsistent w/ stage of CH development
multiple differing hx’s
poor eye contact, nutrition, hygiene
minimizing jnjury, delay in tx
pt clings to suspected batterer
CH excessively attached to or afraid of parent
CH excessively ingratiating to examinar
patterned burns, classic injury patterns

40
Q

classic metaphyseal-epiphyseal injuries of child abuse

A

metaphyseal lucency
corner fx
bucket handle

41
Q

elder abuse

A 
hx does not match bruises or injury
wt loss
dehydration
depression
decubitus ulcerations
poor hygiene
medical "noncompliance"- missed appt, etc
42
Q

developmentally & intellectually disabled (DD & ID) have significantly__________pain thresholds

A

increased
25% have this
atypical & late presentations

43
Q

anxiolytics are often useful when working w/ ?

A

deelopmentally & intellectually disabled pts

44
Q

cardiovascular issues in DD & ID

A

congenital heart dz
great vessels
CAD common as get older

45
Q

infection issues in DD & ID

A 
skin (MRSA)
OM
dental 
UTI/ pyelo
occult infxns
46
Q

injury issues in DD & ID

A 
self0inflicted (often d/t anxiety), abuse
osteopenia common: fx
pica
FBs
bezoars
47
Q

endocrine issues in DD & ID

A

DM
hypothyroidism
vit deficiency

48
Q

psych issues in DD & ID

A

agitation- consider it delirium

49
Q

neurologic issues in DD & ID

A 
seizures very common
delirium more common
hearing loss
vision loss (cataracts)
atlantoaxial instability (Down's)
50
Q

abuse issues in DD & ID

A

DV
sexual assault (3-5x higher than typically developed)
neglect
poor support

51
Q

GI issues in DD & ID

A 
esophagitis
PUD
constipation
fissures
impaction
appy
volvulous
perf
etc. all harder to dx
52
Q

FTT

A

pt’s who cannot adequately care for themselves in their current situation- inadequate care, resources, food, situation

53
Q

social admit

A

admitting a person who doesn’t have anywhere to go- admit until placed by Social Services

54
Q

dumping

A

family disappears, takes a break

55
Q

homeless women

A

always ask about abuse, sexual assault-
common to exchange sex for food, drugs, protection
homeless women w/ kids-very high risk

56
Q

ED work-up for homeless pt

A

undress pt- tx as any other pt

VS, d-stick, UPT, alcohol, tox, assess suicide risk,…….

57
Q

issues in wheelchair, quad/paraplegia often related to?

A 
home support/transfer
catheter issues
infxn
pressure sores
aspiration
58
Q

biggies not to miss in wheelchair, quad/paraplegia pts

A 
fever, abnormal VS
UTI
infected pressure sores, osteomyelitis
pneumonia
GI issues: perf, obstruction
DVT, PE risk from immobility
59
Q

IVDU often have a___________& require higher_________doses d/t tolerance

A

lower pain threshold

narcotic

60
Q

IVDU often require what type of IV access?

A

central line, ULS guided

61
Q

use what to reverse overdose?

A

narcan

observe for 60-90 min

62
Q

IVDU w/ fever DDx

A 
endocarditis
epidural abscess
pneumonia
dyspnea
abscess
wound botulism
cotton fever
63
Q

IVDU & endocarditis

A

S. aureus 50%

tricuspid valve 40%

64
Q

IVDU & epidural abscess

A

back pain w/ weakness & IVDU: MRI

65
Q

pneumonia & IVDU

A

often atypical organisms, TB

66
Q

dyspnea & IVDU

A

think septic pulmonary emboli-CXR

67
Q

abscess & IVDU

A

fever is worrisome

necrotizing fasciitis

68
Q

wound botulism

A

descending wakness
pstosis
weak voice
DTR’s intact

69
Q

coton fever

A

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

70
Q

a complication of “pocket” shooters

A

pneumothorax

71
Q

heroin w/d

A 
n/v
diarrhea
chills
malaise
feeling miserable
72
Q

tx for heroin w/d

A

Benzo’s

IV fluids for dehydration

73
Q

special issues in pts under arrest, prisoners

A 
traumatic injuries
substance abuse in prison
psych issues
manipulative behavior, fictitious illness
FB ingestion

Emergency Med Final (9 decks)

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