Violence & Abuse

Fire/Smoke Exposure

Malignant Neoplasm

Motorized Vehicle Related Injuries

Homicide

Host/Patient Characteristics

Environmental Conducitivity

Agent of Energy Transmission

Established EMS Response Systems

Age < 30 at the time of the initial event

Alcohol use at the time of the initial event

Seat belt use at the time of the initial event

Speeding at the time of the initial event

Intermediate Range Wounds : Soot Deposition

Contact Wounds : Sear Margins

Long Range Wounds : Tattooing/Stippling

Close Range Wounds : Stellate Lacerations

Result when a sharp edged object (eg knife) is forcefully drawn across the skin

Isolated "tissue bridges" are common findings

Associated wound margins abrasions are rare findings

Involved tissue margins are smooth edged and well demarcated

When broken (eg during an MVC), the tempered glass found in rear and side windows tends to produce linear/ stellate lacerations upon contact with intact skin

The front bumper of a vehicle that is actively braking will strike a patient at a higher point that would that bumper if the car was not actively decelerating

Upon a collision, the occupants of a vehicle will initially move in a direction away from the area of primary contact

When broken (eg during an MVC), laminated automotive glass tends to shatter into a multitute of razor edged shards

Immersion burns characteristically exhibit a classic "drip-like" appearance

"Bucket handle" or "corner" fractures commonly occur along the diaphyseal shafts of long bones

Although essentially pathognomonic, retinal hemorrhages are seen in

Anogenital burns are unlikely to occur via hot liquids spilling down into a child's diaper and such wounds should prompt concern for possible child abuse

Distal tibia

Midshaft humerus

Distal femur

Proximal fibula

Elevated liver enzymes are a sensitive marker of clinically signifcant liver injuries

Duodenal hematomas can be seen despite only minor abdominal trauma (eg fall

Trauma is the second leading cause of acute pancreatitis in pediatric patients

Abdominal trauma represents the second most common type of fatal injury in child abuse related deaths

Anogenital lacerations are the most commonly identified traumatic injuries

Copious lubricant (eg Surgilube) should be utilized during the vaginal speculum exam to limit any further injury to already jeopardized tissues

The anterior forchette is the most common site of injury

Powder-free examination gloves should be used to limit the potential for evidence contamination

Post assault, there is a 5 day window in which HIV prophylaxis can be successfully initiated

Standard STD prophylaxis should only be offered after all associated cultures have been processed

The immediate use of an emergency contraceptive can drop the likelihood of becomming pregnant to < 15%

Hepatitis B vaccine should be offered to all patients who have not been previously vaccinated

Under no circumstances should a victim of elder abuse be allowed to leave the hospital and return to a potentially abusive setting

The majority of states have enacted laws dictating the mandatory reporting of suspected elder abuse

By default, elderly patients should be assumed to lack adequate decision making capacity and therefore cannot legally refuse medical care

Unlike victims of other forms of abuse, elder abuse patients rarely develop associated psychological disorders (eg PTSD)

The majority of IPV cases occur outside of the home

Nearly 95% of all IPV victims that seek care in US emergency departments subsequently self-report the abuse to law enforcement individuals

Girls who either witness or directly experience intra-familial violence as children have an increased risk of becoming IPV victims when they reach adulthood

All 50 states have laws that mandate the emergency physician to report all cases of suspected IPV to the appropriate law enforcement individuals

By the age of 18, most US children will have seen over 200,000 acts of violence portrayed on television

Firearm related homicide rates are actually the highest in rural regions of the US

Assault rifles are currently the most commonly utilized firearms in gang-related homicides

Over the past 20 years, there has actually been a drop in the incidence of firearm related deaths in the 15-19 year-old age group

Fully-jacketed rounds are the preferred munition of standard US law enforcement officers

The kinetic energy of a projectile is determined more by its given velocity rather than by its overall mass

The term "magnum", when applied to a firearm round, implies a larger caliber or diameter as compared to a standard "non-magnum" round

Handgun barrels are designed to impart a spin on the projectile as it exits the muzzle

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