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Most popular medical Questions
When are burn injuries suspicious for child abuse?Burn injuries account for about 5% of cases of physical abuse. As with other injuries, the description of the incident causing the burn should be consistent with the child's development and the extent and degree of the burn observed. The following types are suspicious for abuse:
Immersion burns: Sharply demarcated lines on the hands and feet ("stocking-glove" distribution), buttocks, and perineum, with a uniform depth of burn; the immersion of a child in a hot bath is a classic example
Geographic burns: Burns, usually of second or third degree, in a distinct pattern, such as circular cigarette burns or steam iron burns
Splash burns: Pattern with droplet marks projecting away from the most involved area; splash marks on the back of the body usually require another person and may or may not be accidental
In cases of suspected sexual abuse of a child, is it necessary to conduct a full sexual abuse examination immediately, or can the patient be referred to a child advocacy center and child abuse specialist at the earliest possible time?
If you believe the alleged sexual abuse has occurred within the past 96 hours or if there is ongoing bleeding or evidence of acute injury, it is important to complete the medical examination immediately. Accepted protocols for evaluating child sexual assault victims should be followed to properly secure biologic evidence such as semen, blood, and epithelial cells. If the history suggests an event occurring more than 72 hours earlier and there is no acute injury, an emergency examination may not be necessary. The examination can be scheduled at the earliest possible time at a center that specializes in the evaluation of child and sexual abuse.
If physical abuse is suspected, are physicians mandated to photograph physical findings?
No. A good drawing of the physical findings is sufficient. However, if photographs are taken, a card with the patient's name, date of birth, and the photographer's signatures must be included in the photo so that the patient can be clearly identified. In addition, the body part that is being photographed must be clearly identifiable. If abuse is suspected, it is not necessary to obtain parental consent to take photographs.
What are acceptable rewarming methods for the hypothermic child?
For patients with mild hypothermia (32-35C), passive rewarming by removing cold clothing and placing the patient in a warm, dry environment with blankets is generally sufficient. Active external rewarming involves the use of heating blankets, hot water bottles, and overhead warmers and is used for patients with acute hypothermia in the 32-35C range as well. Active external rewarming should not be used for chronic hypothermia (>24 hours). More aggressive core rewarming techniques should be considered for patients with temperatures 32C. These techniques include gastric or colonic irrigation with warm fluids, peritoneal dialysis, pleural lavage, and extracorporeal blood rewarming with partial bypass. Intravenous and other fluids should be heated to 43C. Patients should be given warmed, humidified oxygen by face mask or endotracheal tube.
What two questions are key when considering the placement of an endotracheal tube in a patient who has been in a house fire?
How extensive are the signs of heat exposure in the upper airway? Physical examination may reveal carbonaceous sputum, singed nasal hairs, facial burns, or pulmonary abnormalities. These make the development of swelling of the upper airway more likely and thus prompt consideration of viewing the vocal cords directly to look for signs of impending upper airway obstruction. If significant swelling, erythema, or blistering is seen, intubation should be performed electively to protect the airway from progressive obstruction.
Are there signs or symptoms of impending airway obstruction as a result of mucosal injury and edema? Yes. These include hoarseness, stridor, increasing respiratory distress, and difficulty handling secretions. If present (along with the physical exam
In electrical injury, is alternating or direct current more hazardous?
At low voltages (e.g., those found in household electrical devices), alternating current is more dangerous than direct. Exposure to alternating current can provoke tetanic muscle contractions so that the victim who has grasped an electrical source is unable to let go, thereby prolonging the exposure and producing greater tissue injury. Direct current or high-voltage alternating current typically causes a single forceful muscular contraction that will push or throw the victim away from the source.
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