Acute Care H&S Flashcards
(82 cards)
Fracrtures that are highly specific of non accidental injury
- Metaphyseal fracture (bucket handle fracture or corner fracture)
- rib fractures (especially posterior)
Scapular fractures - Sternal fractures
- Outer third clavicle fractures
- B/L fractures
- Fractures of differing ages
- Skull fractures
which fractures are virtually pathogonomic for NAI
Metaphyseal fracture (bucket handle fracture or corner fracture) - virtually pathognomonic
rehabilitation process after trauma
> Specialist rehab - led by a consultant: assessment, Tx and Mx with ongoing evaluation
Helps them achieve their max potential for physical, cognitive and social function
Other speciality involvement in trauma rehab
> MDT - co-ordinates the rehab
physiotherapy - assessment and mobilisation should occur as quickly as possible (pt hip fractures)
OT, social workers, geriatricians are part of the
MDT who assess needs for discharge
impacts of trauma
> take on sick role
social isolation can occur during recovery
requires time off work
stress
friends/family may have to take on role of carer
When would you consider a NAI
- Delayed presentation in seeking medical attention (may be due to effective first aid measures
masking the severity of the injury) - An unrelated adult presenting the child to healthcare services
- Evasive or changing history
- Trigger event e.g. soiling, enuresis or minor misbehaviour by the person
- History inconsistent with assessed development
- A lack of parental or carer concern
- A lack of appropriate supervision of a vulnerable person (may indicate neglect)
- Failure to engage with healthcare appointments or health promotion programmes (may indicate
neglect) - History incompatible with examination findings
- No splash marks in scald injuries
- Signs of restraint on upper limbs
- Sparing of flexion creases (suggesting child was in foetal position when burned)
- Central sparing (doughnut sign) of the buttocks - may be found is submersion injuries if a person has
been forcibly held down - Associated unrelated injuries (bruises of varying ages)
effective approaches to health promotion in relation to burns and scalds
> fire alarm testing
electrical PAT registration
building regulations
Public area H&S regulations (fire extinguishers, fire exits, fire retardant
materials)
regular fire drilsl
fire safety training
Education to reduce incidence of burns
> SMART (Spend time in shade between 11-3, make sure you’re not burned, Aim to
cover up, remember extra care with children, then use sun cream)
- Use fireguards for open fire
- Do not smoke in bed
- Close door at night to prevent fire spread
Reducing burns in children
> Keep children out of the kitchen unless supervised
- Use back rings on the hobs
- Keep hot objects/candles/matches out of reach of children
- Teach older children how to boil the kettle safely
- Do not drink hot drinks when holding/sitting next to children
- Test bath water before putting child in
who is most at risk of burns
< 5 year olds, 50% of which occur in the kitchen
at risk groups for burns
> children, diabetic neuropathy and > 75s
sociodemographic risk factors for suicide
> male
elderly
low SES, low educational status
Unmarried, separated, divorced, widowed
- Unemployment/insecure employment
- Students
- Prisoners
immigrants
doctors
clinical RF for suicide
> FHx of suicide or mental dsprder
specifical illnesses with higher rates: anorexia, psychosis, severe depression
recent post discharge period
prev suicide attempts
RF during/ after suicide attempts
- Lethality/violent method of attempt
- Large amount of attempts
- Plans for others after death (suicide notes, changes to will,
consequences) - Specific plans/premeditated
- Waiting to be alone/did not expect to be discovered
- No regret/remorse over current/previous attempt
- Still intends to commit suicide
Protective factors against suicide
> cultural/ religious discouragement
friends/ family
limited access to means
professional involved in a psychiatric assessment
> Registered medical practitioner (usually a doctor who knows the pt e.g. GP
- Section 12 approved doctor (usually a psychiatrist)
- Approved mental health professional (AMHP)
who can be an AMHP
May be social workers, nurses, occupational therapists, psychologists`
Section 2 of MHA
Allows for compulsory admission to hospital for a period of assessment and treatment for up to 28 days
- Allows a psychiatrist time to determine what mental disorder a patient has and what treatment options are available
who must make the recommendation for a section 2 order
Two doctors - one approved under section 12 and one who is previously known to the patient e.g. GP must make a recommendation that the patient be detained
who must make the APPLICATION for a section 2
Nearest relative or AMHP must make application
- Unlike section 3 can be detained even if nearest relative objects
section 4/ a.k.a emergency order
Allows for admission to hospital for assessment in cases of emergency
- Lasts up to 72 hours (If it requires longer they will need to be put on section 2 or section 3)
a section 4 DOES NOT ALLOW FOR
TREATMENT
who must sign for a section 4
Must be signed by a doctor and either an AMHP or patient’s nearest relative
section 4 should only be used when
Should only be used when urgent hospital admission is required and putting the patient on a Section 2 would result in an undesirable delay
