jan2013 ce powerpoint part 3

When is the abuse victim at greatest risk for significant injury?

Priority One… Scene Safety

Ask direct questions gentlygently

• “I noticed you have a number of bruises. Could you tell me what happened? Did someone hit you?”

• “You seem frightened of your partner, Has he ever hurt you?”

• “Sometimes pts tell me they have been hurt by someone close to them. Is this happening to you?”

…then listen

Please read the Please read the scenario found in scenario found in

handouthandout

Policy Review

V-4

Homelessness

EMS dispatched at 2400 to local church for EMS dispatched at 2400 to local church for “sick person”“sick person”

16 M shivering; pale & diaphoretic; in mild 16 M shivering; pale & diaphoretic; in mild respiratory distressrespiratory distress

h/o physical abuse from mothers boyfriend, h/o physical abuse from mothers boyfriend, drug & alcohol addiction; last heroin use 3 drug & alcohol addiction; last heroin use 3 days ago & hasn’t eaten in 2 daysdays ago & hasn’t eaten in 2 days

c/o cough, chills, fatigue & body aches for 2 c/o cough, chills, fatigue & body aches for 2 days w/ vomiting, dry heaves & abdominal days w/ vomiting, dry heaves & abdominal cramps for past 12 hourscramps for past 12 hours

VS: BP 100/60, HR 124, R 28, SpOVS: BP 100/60, HR 124, R 28, SpO22 92% 92%

Homelessness…let’s talkHomelessness…let’s talk

What preconceived ideas come to mind when thinking about the homeless?

“Treating homeless patients can present overwhelming

challenges for EMS providers”

Court Hears Actor Mickey Court Hears Actor Mickey Rooney's Allegations of Rooney's Allegations of

Elder AbuseElder Abuse

By Caroline Tan Monday, Jul 9, 2012

Famed actor Mickey Rooney has accused his stepson of elderly

abuse

Elder AbuseElder Abuse

PhysicalPhysical

EmotionalEmotional

SexualSexual

ExploitationExploitation

NeglectNeglect

AbandonmentAbandonment

Self-neglectSelf-neglect

Who does the abusing?Who does the abusing?

Family membersFamily members

Home care giversHome care givers

Long term care facilitiesLong term care facilities

Newly found “friends”Newly found “friends”

ScenarioScenarioRewrite narrative Rewrite narrative

objectivelyobjectively

EMS is dispatched to a residence EMS is dispatched to a residence for an adult female w/ MS, who is for an adult female w/ MS, who is

too weak to get out of bed.too weak to get out of bed.

What is objective?What is objective?

What is subjective?What is subjective?

How about this…How about this… Upon arrival to a single Upon arrival to a single

family home, found an family home, found an adult female in bed on adult female in bed on first floor/attic/basement first floor/attic/basement bedroom. History of MS, bedroom. History of MS, normally able to transfer normally able to transfer from bed to motor scooter from bed to motor scooter independently, however, independently, however, today too weak to get out today too weak to get out of bed.of bed.

Upon arrival to single family home, found an adult Upon arrival to single family home, found an adult female in bed on first floor/attic/basement BR. female in bed on first floor/attic/basement BR. History of MS, normally able to transfer from bed to History of MS, normally able to transfer from bed to motor scooter independently, however, today too motor scooter independently, however, today too weak to get out of bed. Immediate odor of urine & weak to get out of bed. Immediate odor of urine & feces noted along with dried feces seen on bedding, feces noted along with dried feces seen on bedding, chair pad & clothing. Multiple dirty diapers are on chair pad & clothing. Multiple dirty diapers are on the floor. Upon daughter escorting us to pt’s room, the floor. Upon daughter escorting us to pt’s room, spouse not making eye contact with EMS, only spouse not making eye contact with EMS, only stating, “There’s nothing wrong w/ her. She doesn’t stating, “There’s nothing wrong w/ her. She doesn’t need to go to the hospital,” & promptly went to need to go to the hospital,” & promptly went to another room. Found pt. A&Ox3, tearful, no oral another room. Found pt. A&Ox3, tearful, no oral fluids were w/in pt’s reach; reporting her normal fluids were w/in pt’s reach; reporting her normal function is decreased today. States normally she function is decreased today. States normally she has good sensation & weak movement to all parts, has good sensation & weak movement to all parts, but today, range of movement & strength are but today, range of movement & strength are reduced; the feeling in her lower legs is limited. reduced; the feeling in her lower legs is limited. Normally painful for limbs to be moved passively, Normally painful for limbs to be moved passively, but she has no pain at rest, including today.but she has no pain at rest, including today.

Stroke screen is abnormal as pt is unable to resist Stroke screen is abnormal as pt is unable to resist gravity w/ either arm which she is normally strong gravity w/ either arm which she is normally strong enough to do so. The pt also notes she is having enough to do so. The pt also notes she is having trouble speaking today as well. Stroke screen trouble speaking today as well. Stroke screen reveals speech to be clear, normal, appropriate, w/ reveals speech to be clear, normal, appropriate, w/ no facial asymmetry.no facial asymmetry. Pt is incontinent of stool & Pt is incontinent of stool & urine (normal for her); scene delay for clean up & urine (normal for her); scene delay for clean up & repositioning pt to arrange for safe transfer from repositioning pt to arrange for safe transfer from bed to stretcher. During transfer, noted reddened bed to stretcher. During transfer, noted reddened areas on coccyx & R hip. Skin hot to touch; oral T areas on coccyx & R hip. Skin hot to touch; oral T 98.7. c/o being very thirsty. Oral membranes dry; 98.7. c/o being very thirsty. Oral membranes dry; skin turgor w/tenting.skin turgor w/tenting. Pt reports discomfort at Pt reports discomfort at surgical site (hernia repair 3 wks ago) that began surgical site (hernia repair 3 wks ago) that began yesterday. Incision is dry, edges well yesterday. Incision is dry, edges well approximated, w/ no drainage noted. Mild redness approximated, w/ no drainage noted. Mild redness noted in umbilical area of incision. Pt denies chills, noted in umbilical area of incision. Pt denies chills, fever, or burning w/ urination. Venous access fever, or burning w/ urination. Venous access unsuccessful.unsuccessful.

When pt. alone w/ EMS, the ptWhen pt. alone w/ EMS, the pt states her spouse provides her states her spouse provides her

very little care, & very little care, & that it is fortunate that it is fortunate that her daughter that her daughter was able to come was able to come today, as she today, as she (her daughter) is (her daughter) is the only one who the only one who truly takes care of truly takes care of her, and that “he her, and that “he doesn’t do anything”. doesn’t do anything”.

Policy ReviewPolicy Review

V-3V-3

Suspected Elder Suspected Elder Abuse and NeglectAbuse and Neglect

Did anything presented today help you in a new way

to care for your patients?

Thanks for listening