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special pops Flashcards

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1
Q

coroner is called if

A

dead in the field or hospital if
suspicious or unnatural

do not call unless you have a license

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2
Q

the role of the ED is

A 
evidence detection 
evidence preservation 
evidence collection
documentation
preserve the chain of custody 
and cooperate with law enforcement

avoid any comment that is subjective

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3
Q

SART stands for

A

sexual assault response team

includes SANE

non physician forensic examiners

DA’s office

police

crime lab

familiarity with local crime patterns

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4
Q

SANE stands for

A

sexual assault nurse examiners

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5
Q

what happens in a sexual assault exam

A

STABALIZE

need to determine which jurisdiction did this happen

the police of this jurisdiction need to handle the case

advocate is with the patient

California 923 form -state protocol

evidence collection: swabs, hair, vaginal secretions
colposcopy, toulidine blue

Screening and prophylaxis for STI and pregnancy

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6
Q

toluidine blue is for

A

looking at fresh abrasions in areas of redundencu

adheres to the nuclei of injured cells

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7
Q

prophylactic medications

A

treat for gonorrhea and chlamydia prophylactically

pregnancy prophylaxis

NOT HIV prophylaxis

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8
Q

HIV prophylaxis

A

need a very high viral loud

and a low T cell count

in the presence of abrasions it is higher but it is very unlikely that this would be the case

HOWEVER anal penetration with ejaculation is much higher especially if their are lesions at the anus

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9
Q

colposcopy

A

binocular magnifying device that allows for photographs of genitalia

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10
Q

two most common sites of vaginal abrasions

A

posterior frouchette

fossa navicularis

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11
Q

management of anal rape

A

colposcopy and anoscopy to look for and document injury

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12
Q

absence of vaginal injury is

A

common 50% will be seen with no genital injury

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13
Q

cold hits

A

national DNA database that allows for connection to perpetrators

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14
Q

SAFE

A

safety
afraid
friends/family
emergency plan

prepared for a pt who does not wish to report or accept resources

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15
Q

lethality index -high risk for homicide

A 
choking
gun in home 
threat to kill themselves
alcohol or drug use
sexual assault

sexual assault+ choking+stalking

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16
Q

edler abuse signs

A 
injury does not match bruises or injury
Weight loss
Dehydration
Depression
Decubitus ulcerations
Poor hygiene
Medical “noncompliance”
--> why are they not coming to the hospital 
Missed appointments, etc
“Dropped off” at ED – no one available

APS should be contacted (adult protective services)

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17
Q

common cardio issues in adutls with DS

A

Congenital heart dz, great vessels

CAD common as get older

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18
Q

infection in DS

A

pylo occult skin as well as

Skin (MRSA), otitis media, dental, UTI/pyelo,

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19
Q

injuries that can be common to adults with DS

A

self-inflicted (often d/t anxiety), abuse, neglect
Osteopenia common: fx
Pica, Foreign Bodies, bezoars

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20
Q

endocrine in adults with DS

A

Diabetes, hypothyroidism

Vitamin deficiency

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21
Q

psych issues in adults wtih DS

Study These Flashcards
A

Agitation – consider acute delirium

22
Q

neuro issues in adults with DS

Study These Flashcards
A

Seizures very common
Delirium more common
Hearing loss, vision loss (cataracts)
***Atlantoaxial instability (Down’s)

23
Q

GI issues in adults with DS

Study These Flashcards
A

Esophagitis, PUD
Constipation, fissures, impaction
Appy, volvulous, perf, etc…all harder to diagnose

24
Q

abuse in adults with DS

Study These Flashcards
A

DV sexual assualt x3 higher than average populations

neglect, and poor support

25
define FTT
pts who cannot adequately care for themselves in their current state of situation inadequate care or resources
26
most of the time pts that have FTT to present because of
Overwhelming medical condition (For example – they faint at walgreens) Sudden deterioration or delirium? Work it up
27
ED workup for homeless patient
``` vitals d-stick pregnancy test alcohol utox assess suicide risk psych issues worry about alcohol withdrawl feed the pt ```
28
big issue with quad/paraplegic pts and fever
Urinary tract infections – most common*** infected pressure sores, osteomyelitis Pna, GI issues, perf, obstruction
29
UTI in plegia think
self-catheter or indwelling catheter huge risk for UTI/pyelo-change catheter, culture silent sxs hydronephrosis
30
injected pressure sores in pt with plegia worry about
chronic osteomyelitis need to inspect all would care
31
always worry about this in wheelchair pt
DVT and PE risk from immobility symptoms are silent!
32
IVDU pain threshold
lower and tolerance--> may need more pain medications overdose-narcan
33
when can you discharge a patient that is withdrawing
60-90 minutes after narcan can discharge
34
when can you give methadone
only for admitted patient
35
when would you give suboxone
if they are ready to quit today and withdrawing
36
IVDU with a fever worry about
``` endocarditis epidural abscess PNA dyspnea abscess wound botulism cotton fever ```
37
endocarditis in IVDU think...
Staph Aureus 50%, tricuspid valve 40%
38
back pain w/ weakness & IVDU get what
back pain w/ weakness & IVDU: emergent MRI | --->Epidural abscess
39
PNA IVDU worry about
often atypical organisms, TB
40
abscess in IVDU worry about
fever is worrisome – necrotizing fasciitis
41
dyspnea in IVDU worry about
Dyspnea? Think septic pulmonary emboli - CXR
42
wound botulism in IVDU would look like
descending weakness, ptosis, weak voice, DTR’s intact
43
what is cotton fever
rapid onset flu-like sx’s, benign, resolves 24hrs did they filter their heroin with cotton
44
pocket shooters worry about
pneumothorax if miss if needle breaks off XRAY!
45
heroin withdrawal will look like what
N/V, diarrhea, chills, malaise - miserable
46
tx heroin withdrawal with
Tx with Benzo’s, IV fluids for dehydration
47
EDs role with prisoners
medical clearance for jail arrest injuries sustained during crime or arrest forensic evidence -alcohol level incarcerated pts with serious medical issues
48
biggest issue with prisoner pts
confidentiality !
49
special issues for pts in prisons
Traumatic injuries Substance abuse in prison Sexual assault Psych issues Manipulative behavior, fictitious illness (blood in urine – men can cut their own penis) Foreign body ingestion
50
breach of security issue with prisoner patients
Inmate cannot know appointment date/time must be fit for incarnations

Emergency Medicine (28 decks)

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