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Flashcards in special pops Deck (50):
1

coroner is called if

dead in the field or hospital if
suspicious or unnatural


do not call unless you have a license

2

the role of the ED is

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

avoid any comment that is subjective

3

SART stands for

sexual assault response team

includes SANE

non physician forensic examiners

DA's office

police

crime lab

familiarity with local crime patterns

4

SANE stands for

sexual assault nurse examiners

5

what happens in a sexual assault exam

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

6

toluidine blue is for

looking at fresh abrasions in areas of redundencu

adheres to the nuclei of injured cells

7

prophylactic medications

treat for gonorrhea and chlamydia prophylactically

pregnancy prophylaxis

NOT HIV prophylaxis

8

HIV prophylaxis

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

9

colposcopy

binocular magnifying device that allows for photographs of genitalia

10

two most common sites of vaginal abrasions

posterior frouchette

fossa navicularis

11

management of anal rape

colposcopy and anoscopy to look for and document injury

12

absence of vaginal injury is

common 50% will be seen with no genital injury

13

cold hits

national DNA database that allows for connection to perpetrators

14

SAFE

safety
afraid
friends/family
emergency plan

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

15

lethality index -high risk for homicide

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

sexual assault+ choking+stalking

16

edler abuse signs

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)

17

common cardio issues in adutls with DS

Congenital heart dz, great vessels
CAD common as get older

18

infection in DS

pylo occult skin as well as

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

19

injuries that can be common to adults with DS

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

20

endocrine in adults with DS

Diabetes, hypothyroidism
Vitamin deficiency

21

psych issues in adults wtih DS

Agitation – consider acute delirium

22

neuro issues in adults with DS

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

23

GI issues in adults with DS

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

24

abuse in adults with DS

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