special populations Flashcards
Forensic?
pertaining to or belonging to the legal process
Forensics to the healthcare practitioner.
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
“Evidence is fleeting”
time sensitive
ED role with evidence?
Evidence detection Evidence preservation Evidence collection if appropriate Documentation Preserve “chain of custody” Cooperate/work with Law Enforcement
Observe the state of the injury
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
Vascular integrity is the priority in extremities
Pulses, pallor, cold distal?
Sensory exam
Knife/Stab Wounds
Good history, police report
Arterial Bleeding - Extremity
Universal precautions
wear your protective shit!!!
Arterial Injury Testing: ABI
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
Arterial Pressure Index (API)
Compare upper or lower extremities to each other
API = Injured SBP/Uninjured SBP
concern for vascular injury?
> 0.9 normal; if less
Duplex ultrasound, ateriogram if <0.9
Pseudoaneurysm concern
Absence of genital injury is common?
up to 50% have zero findings
Absence of genital injury does not?
imply consent
S.A.F.E. Questions
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?
True or False?Healthcare providers are good at recognizing DV?
false
False: only 8% of injuries/ailments are correctly attributed to DV
True or False?
DV murders are unexpected?
false
False: 44% of women murdered by DV have ED visit for DV w/in 2yrs of death
True or False?
DV victims are not known to healthcare system.
false
False: 23% of DV pt’s have 6-10 ED visits, 20% have >11 prior visits before recognition
Recognizing Child Abuse
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
bucket handle injuries
indicative of child abuse…
Elder Abuse presentation.
Hx does not match bruises or injury Weight loss Dehydration Depression Decubitus ulcerations Poor hygiene Medical “noncompliance” Missed appointments, etc
what do you do for Developmentally and Intellectually Disabled
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
Anxiolytics def
s a drug used for the treatment of anxiety and its related psychological and physical symptoms.
MC inf in Wheelchair, Quad/Paraplegia pts?
UTI
Wheelchair, Quad/Paraplegia
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
