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Emergency Head and Neck > 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

Forensics to the healthcare practitioner.

A

ED providers are the interface between the patient and the state in public health, legal and justice systems
Reporting requirements
Medical record is discoverable; valuable as first record of event

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3
Q

“Evidence is fleeting”

A

time sensitive

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4
Q

ED role with evidence?

A 
Evidence detection
Evidence preservation
Evidence collection if appropriate 
Documentation
Preserve “chain of custody”
Cooperate/work with Law Enforcement
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5
Q

Observe the state of the injury

A

acute or old

Thorough history, thorough exam
Measure, describe injuries
Don’t throw evidence away or wash it off
Clothing, debris, stains, foreign bodies, etc.
Do not alter the wound(s) if possible
Describe exactly and only what you observe

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6
Q

Vascular integrity is the priority in extremities

A

Pulses, pallor, cold distal?

Sensory exam

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7
Q

Knife/Stab Wounds

A

Good history, police report

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8
Q

Arterial Bleeding - Extremity

Universal precautions

A

wear your protective shit!!!

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9
Q

Arterial Injury Testing: ABI

A

Comparison of ipsilateral upper and lower extremity systolic pressure
Pt supine, BP cuff, doppler
Doppler brachial SBP, then highest of dorsalis pedis and posterior tibial
ABI = Ankle SBP/Brachial SBP

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10
Q

Arterial Pressure Index (API)

A

Compare upper or lower extremities to each other

API = Injured SBP/Uninjured SBP

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11
Q

concern for vascular injury?

A

> 0.9 normal; if less

Duplex ultrasound, ateriogram if <0.9
Pseudoaneurysm concern

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12
Q

Absence of genital injury is common?

A

up to 50% have zero findings

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13
Q

Absence of genital injury does not?

A

imply consent

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14
Q

S.A.F.E. Questions

A 
Safety/Stress
	Do you feel safe now? Stressors?
Afraid/Abused
	Afraid now? Abused before?
Friends/Family
	Do friends/family know?
Emergency Plan
	Prepared and/or safe place to go?
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15
Q

True or False?Healthcare providers are good at recognizing DV?

A

false

False: only 8% of injuries/ailments are correctly attributed to DV

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16
Q

True or False?

DV murders are unexpected?

A

false

False: 44% of women murdered by DV have ED visit for DV w/in 2yrs of death

17
Q

True or False?

DV victims are not known to healthcare system.

A

false

False: 23% of DV pt’s have 6-10 ED visits, 20% have >11 prior visits before recognition

18
Q

Recognizing Child Abuse

A

Injuries inconsistent with history
***Injuries inconsistent with stage of child development
Multiple differing histories
Poor eye contact, nutrition, hygiene
Minimizing injury, delay in treatment
Patient clings to suspected batterer
Child excessively attached to or afraid of parent
Child excessively ingratiating to examiner
Patterned burns, classic injury patterns

19
Q

bucket handle injuries

A

indicative of child abuse…

20
Q

Elder Abuse presentation.

A 
Hx does not match bruises or injury
Weight loss
Dehydration
Depression
Decubitus ulcerations
Poor hygiene
Medical “noncompliance”
Missed appointments, etc
21
Q

what do you do for Developmentally and Intellectually Disabled

A

85% estimated to operate intellectually at 5th grade level – you must adjust
25% have significantly increased pain thresholds – atypical and late presentations
Caretakers are key – establish baseline, clarify medical history, know approach, how to keep pt calm

22
Q

Anxiolytics def

A

s a drug used for the treatment of anxiety and its related psychological and physical symptoms.

23
Q

MC inf in Wheelchair, Quad/Paraplegia pts?

A

UTI

24
Q

Wheelchair, Quad/Paraplegia

A 
Biggies not to miss:
Fever, abnormal VS always significant
Urinary tract infections
Self-catheter or indwelling catheter
Huge risk for UTI/pyelo – change catheter, culture
“Silent” sx’s, hydronephrosis
Infected pressure sores, osteomyelitis
Inspect all, wound care consult
Chronic osteomyelitis common
Pneumonia; GI issues: perf, obstruction
DVT, PE risk from immobility
25
Q

IVDU

A

need to get central line placement because the veins are so bad

The route is a problem
“Skin popping” when veins run out

26
Q

Cotton fever

A

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

27
Q

“Pocket” shooters

A

pneumothorax if miss

28
Q

Heroin withdrawal sx’s and tx

A

N/V, diarrhea, chills, malaise - miserable

Tx with Benzo’s, IV fluids for dehydration

29
Q

never tell a prisoner?

A

this is your f/u date because they might plan an escape….

Emergency Head and Neck (9 decks)

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