Emotional Abuse Test

(Rosen's 947)

(Rosen's 1018)

Firearm related homicide rates are far and away highest in inner city populations in the US. Handguns are used in > 80% of all gang-related homicides followed by shotguns (8%) and assault rifles (5%). In the last 20 years, there has been a 75% increase in the incidence of firearm related deaths in the child and adolescent age groups. (Rosen's 1019-1021)

In all of these age groups, MV related injuries are the leading cause of death. Malignant neoplasms are #2 in children between 4-15 years of age, whereas in individuals between the ages of 16-34, homicide is #2 closely followed by suicide at #3, (Rosen's pg 942)

Anogenital abrasions are the most commonly identified traumatic injuries post sexual assault, and the most commonly affected site is the posterior forchette. Water and water alone should be the only lubricant utilized in the vaginal speculum exam due to the potential for synthetic lubricants to interfere with proper evidence collection. (Rosen's pg 985-987)

Unlike cases of child abuse, victims of elder abuse are competent individuals with the right to dictate their own medical care. Their wishes, even if to return to a potentially abusive situation, need to be respected. Psychological disorders including PTSD are very common in victims of all forms of abuse. (Rosen's 1014-1015)

The cornerstones of the "Injury Triangle" are the Host, Agent, and Environment. All subsequent treatment, whether pre-hospital or ED based, is not included in the actual theory. (Rosen's pg 941)

A CAST (Childhood Accidental Spiral Tibial) or "Toddlers" fracture is a non-displaced oblique fracture of the distal third of the tibia that results when a minor rotational force is applied to a weak porous section the of bone. These injuries commonly result from minor falls and present as a limping child without any clear mechanism of injury. (Rosen's pg 975)

The majority of cases of IPV occur within the household between the times of 6P-6A. The universal reporting of cases of IPV has not been mandated across all states. The number of IPV victims that self report their abuse to law enforcement individuals is far less than 95%. (Rosen's 995, 1005)

Kinetic energy is proportional to the mass of an object multiplied by its velocity squared (KE = 1/2 mv^2), and therefore velocity is the key component to determining the KE of a given projectile. Standard law enforcement officers use hollow-point rounds to limit any collateral damage to non-combatants. The term magnum refers to rounds that have larger casings and thereby contain more gunpowder which in turn imparts a greater velocity to the projectile. Rifle barrels and not handguns are designed to impart a spin on the bullet as it exits to muzzle to improve its stability in flight and overall accuracy. (Rosen's 954-959)

(Rosen's 970)

(Rosen's 1019)

"Pattern lacerations" are tears in the skin caused by blunt trauma. By default, they typically exhibit irregular crushed or abraded skin edges and pathognomonic "tissue bridges". Drawing a sharp edged implement across the skin produces an incision type wound. (Rosen's pg 962)

Tempered (or "safety") automotive glass, as found in rear and side windows, tends to fragment into small cubes when broken and imparts a dicing pattern of injury to the skin. Laminated automotive glass as seen on a windshield is composed of two layers of glass laminated together with a thin layer of clear plastic sandwiched between. This type of glass will shatter into shards that impart incision type wounds to the skin. The front end of a vehicle that is actively braking will dip down toward the street and contact a pedestrian at a lower point than if the brakes were not applied. Due to inertia, when a moving vehicle contacts another object, the inhabitants will initially move towards the point of contact. (Rosen's pg 965-966)

In the case of motor vehicle injury, the three behavioral risk factors most likely to result in future crash are speeding, seat belt nonuse, and driving after drinking alcohol. Age has not been shown to be a relevant factor.(Rosen's pg 947)

Tissue injury occurs when kinetic energy is transferred from an object to said tissue. Therefore, the overall degree of tissue damage is proportional to the amount of energy transferred between a projectile and its target tissue and is not dictated solely by the total energy that the given projectile possess. (Rosen's 959)

Soot deposition is classically seen in close range wounds, tattooing/stippling is pathognomonic for intermediate range wounds, and both sear margins and stellate lacerations are associated with contact wounds. (Rosen's pg 955-956)

Accidental "spill burns" in children are associated with a classic "drip-like" appearance where the severity of injury is inversely proportional to the distance from the contact site. Bucket handle and corner fractures are chip fractures of the metaphysis of long bones that arise when a torsional or shearing force is applied to a limb and are pathognomonic for abuse. Retinal hemorrhages accompany approximately 75% of all cases of shaken baby syndrome. Children's disposable diapers are very absorbent of both liquid and heat, and therefore any scald burns in the anogenital area that are attributed to hot beverages falling into a child's diaper should be scrutinized carefully. (Rosen's 970-971)

Histories of "falls" are commonly related in children presenting with severe inflicted abdominal trauma. Although falls may lead to abdominal wall contusions and rarely splenic injuries, they are unlikely to cause duodenal hematomas, intestinal perforation, of liver lacerations. (Rosen's pg 972)

To maximize the likelihood of success with post-SAV HIV prophylaxis, treatment should be initiated as soon as possible and definitely within 72h of the event. With regards to STD cultures, they are often expensive and offer no forensic value. As well, not all juristictions will automatically pay for this form of testing in the SAV. Given this, a more prudent course of action would entail empiric coverage for GC, Chlamydia, and Trichomonas (eg Ceftriaxone 125mg IM, Azithromycin 1g PO, and Metronidazole 2g PO). The immediate use of an emergency contraceptive can reduce the risk of pregnancy to 1-2%. Hepatitis B vaccination is recommended for SAV's who have not been previously immunized. Concurrent hepatitis B immunoglobulin administration is not necessary. (Rosen's 989-991)