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Flashcards in DOMESTIC VIOLENCE Deck (66):
1

What is difficult about victims of domestic violence and why they go back to their abuser?

Want the abuse to end, but not the relationship. Still love their abuser. Have no support from family or friends. They often have children with their abuser and fear for their safety if they leave.

2

A women who experiences domestic violence is more likely to have what?

Stroke, heart disease, asthma, alcoholism

*We must always respect their decision

3

What is our role as a medical provider in domestic violence?

Screening, assessment, intervention (Safety planning, validation), documenting, referrals

4

“I see patients who are being hurt or threatened by someone that they love, is this happening to you?” “Domestic violence is a problem in peoples lives so I ask every patient I see about the safety of their relationship. Do you feel safe in yours?” Are all examples of what?

Screening questions

5

Evaluating the injuries, pattern of abuse, immediate safety (safe houses), danger and potential lethality, potential suicide/homicide are examples of what?

Assessment

6

What are some patterns of abuse?

Injury inconsistent with history, bruising (multiple areas, different stages of healing, symmetrical bruise), burns, abrasions/scratches, pattern of injury

7

What are some common areas of abuse?

Back of head, neck/shoulders, face, posterior arms, thighs, buttocks, and back

8

When you express concern for health/safety privately; offer support and services; being non-judgmental, RESPECT their choices – are examples of what?

Validation

9

What’s involved in medical treatment & saftery planning?

Medical care of injuries; provide hotline numbers; use community resources

10

What are some things to remember with documentation?

The detail of abuse (use specifics – names, locations, dates, witnesses); use direct quotes; use body maps or photography; ask permission to notify their PCP

11

What should we always ask the patient when we learn that there is domestic violence occurring?

Ask if they want to report

12

What’s one of the most lethal forms of DV?

Strangulation

13

What must you always ask when they report DV?

Ask about strangulation (did he choke you?)

14

What structures are often affected with strangulation?

Carotid arteries (11lbs of pressure x 10 seconds = unconsciousness

Jugular veins (4.4lbs of pressure x 10 second = unconsciousness/3 minutes permanent damage)

Tracheal occlusion (33lbs can fracture the cartilage)

15

Voice changes, difficult or painful swallowing, shortness of breath, mental status change, long term memory loss, PTSD, and loss of bladder/bowel control are sxs of what?

Strangulation

16

If you notice hoarse voice, bruising/abrasion to the neck, HA, painful swallowing, petechiae (face, eyes, eyelids) – are PE findings of what?

Strangulation

17

So where should you always look when you suspect DV?

EYES! For petechiae

18

If there was significant strangulation, what imaging might you need to do?

MRI or CTA of neck – dissection can occur later!!

19

Domestic violence, parent/caregiver psych problems/substance abuse, low birth weight/colicky baby/frequent tantrums are risk factors for what?

Child abuse

20

Injuries without history of trauma, changing history, different history from one historian to the next, explanation inconsistent with injury, delay in seeking care are all what?

Red flags for child abuse

21

What is critical to do on PE with suspected child abuse?

Head to toe assessment, undress the child & fully expose the skin to document all injuries.

Fundoscopioc (retinal hemorrhage)

Intraoral exam (petechiae)

Anogenital exam

22

Bruising on the front of the body, over bony prominences, extremities, and forehead – accidental or not?

Accidental

23

Bruising on the trunk, ear, neck, cheeks, buttocks – accidental or not?

Non-accidental bruising

24

What do you do when you see non-accidental bruising?

Photodocument

25

What must we remember about kids under the age of 6 months?

They don’t walk…

26

What laboratory studies should we do in infants with bruising?

CBC, coag studies, and funduscopic (to r/o big things, like leukemia)

27

If you see burns that are asymmetric, irregular borders on face/neck/upper torso, palms, fingers – accidental or no?

Accidental

28

If you see burns in immersion patterns (often on the butt), sharp demarcation with spared areas on the dorsal hands, back, buttock, and feet – accidental or no?

Nope

29

If you see a fracture in a non-ambulatory child, especially humerus, femur, or ribs, what must you do?

Suspect abuse

Skeletal survey xrays → check for additional fractures

30

If you suspect any sort of head trauma (hematoma, injury, child not acting right) what should you do?

CT brain

31

If you see a skull fracture, what should you do>?

skeletal survey

32

External bruising only present in 20% of cases with what type of injury? What labs should you get?

Liver & small bowel

LFT’s will be elevated & CT scan is best

33

What non-abuse things must we always consider?

Osteogenesis imperfecta, Mongolian blue spots (buttocks), coining/cupping, moxibustion (circular red burns on area involved – burning an herb)

34

IF you suspect child abuse, what must you do?

REPORT IT!!! & always consider siblings in the home

Report – DHHS & Law enforcement

35

What is mandatory reporting in infants?

Under

36

Where does elder abuse most commonly occur?

Common in community setting & long-term care settings

37

Is elder abuse more common in men or women?

Equal

38

What does RADAR stand for?

R = routinely ask about abuse

A = ask questions in private

D = document your findings (body map/photography)

A = Assess for safety

R = Resources & review options (safety plan, local services)

39

If you suspect elder abuse, who do you report to?

DHHS

40

If you have confirmed elder abuse, what do you do?

Report to adult protective services

Alert law enforcement

Safety planning/admission

41

What are some different forms of elder abuse? What’s most common?

Physical, emotional, sexual, financial, neglect, abandonment, and self-neglect

Neglect is most common

42

What are the components of the sexual assault forensic medical evaluation?

History (using patients own words/quotes), PE/injury documentation, evidence collection, documentation, assure advocate can be present, medical treatment, and appropriate follow-up/safety planning/discharge support

43

Most victims of sexual assault are females younger than what age?

24

44

What is a SAFE?

Sexual assault forensic examiner

45

What does a provider do when a SAFE is available?

Limited medical history/screening; ABC’s, explain that the SAFE will be obtaining the full history; if patient must be undressed for medical necessity (collect all clothing & preserve all evidence), obtain UA and keep it on ice

46

What is the chief complaint when the SAFE is available?

Reported sexual assault (NOT “alleged”)

47

If a SAFE is not available, what medical treatment should you do?

Use your kit!
Pregnancy, STI prophylaxis, evaluates risk for HIV, symptomatic management, and consider mental health

48

How many days post assault can you still collect data?

5 days

49

When does the forensic kit have to be picked up?

You MUST stay with the kit until law enforcement comes and you must document all changes of hands → maintain a chain of custody

50

If you have a prebuescent female what exams must you withhold from doing?

Speculum exam & blind vaginal swabs

51

If a patient declines a speculum exam, how else can you get data?

Blind vaginal swabs (for semen)

52

What is the best technique to visualize female child’s anatomy, the hymenal ring, and assess for injury?

Labial Traction (pull out and down)

53

In sexual assault, uncontrolled bleeding, head injury with history of LOC, strangulation with history of LOC, abdominal pain, cervical spine injury, concern for bony fractures are all apart of what?

Immediate medical intervention!! Sexual assault patient is a TRAUMA patient

54

What are some of the long term sequelae for sexual assault?

Depression, Drug/ETOH, PTSD, suicide attempt

Thus, F/U is critical

55

Why should a sexual assault victim be NPO?

Because you need to swab the mouth!!

56

How do you treat pregnancy prophylaxis?

Emergency postcoital contraception → Plan B (Levonorgesrel) & Ella (Ulipristal if over 165lbs) (can be taken up to 5 days after assault)

But its not 100%!

57

How do we treat STI’s prophylactically?

Azith 2grams + Ceftriaxone 250mg IM single dose (covers gonorrhea & chlamydia)

Flagyl (Trich & Bacterial vaginosis) – remember* if they drank in the past 24 hours, start Flagyl the next day

58

How would you treat Hep B prophylaxis?

Immunized – none

Unimmunized – Heptavax ( + Ig if highly suspected!)

59

How would you treat genital herpes?

None – just educate the patient

60

If it is known that the attacker has HIV – what can you do?

PEP – must be started within 72 hours

Truvada & Kaletra

More likely if anal intercourse

61

How does the testing for HIV go?

HIV test at baseline, follow-up at 3 and 6 months

*Must counsel!

62

When and who should a sexual assault patient follow-up with?

PCP or GYN in 2-4 weeks

If HIV – f/u in 3-5 days

63

What is considered an acute setting of child sexual abuse?

less than 72 hours – call the SAFE in

64

If a child is complaining of anogenital problems – what must you do?

Do a medical history and exam. If concern, consult a SAFE

65

What do you when trying to obtain a history from a pediatric patient when you suspect sexual abuse?

NEVER take a history from a parent (have the parent sit behind the patient)

Use their language & always record in verbatim/quotes

66

What’s important for pediatric sexual assault exams?

Head to toe; Explain what you’re doing; ano-genital on the parents’ lap; use labial traction as needed