HA exam 3 domestic violence/nonfatal strangulation

health impacts

autoimmune dx: lupus, psoriasis, crohn's, hashimotos thyroiditis
CV: HTN, hyperlipidemia
GYN and reproductive health: UTIs, infertility
unwanted/unintended pregnancy, preterm delivery
neuro: amnesia, headache, seizure, TBI
mental health
substance abuse

red flags

frequent visits
fearful, timid, submissive
signs of basic needs not being met
injuries in various stages of healing
multiple or vague complaints
injuries during pregnancy
inconsistent medical hx
story changing, inconsistent w injuries
unexplained symptoms
delay in care
no control over money or ID
appear to be coached
accompanying person speaks for them/does not leave bedside

palpation

depending on consent
evaluation of skin integrity
tenderness

evidence

collection from the body or clothing
photos

medication education

STI prophylaxis
HIV PEP
emergency contraceptive

documentation

demographic
past and current medical and surgical hx
allergies
hx of assault
PE, photos, evidence collection
discharge instructions
referrals
resources

6 principles of TIC

safety
transparency and trustworthiness
peer support
collaboration
empowerment
cultural and historical sensitivity

how to screen

private
validation
non-judgemental, direct
empathetic
never bad mouth the abuser
transparent, limitation to confidentiality

when to screen

triage, new pt
encounter for new cc
periodic visits, annual
new relationship
every OB visit
concerns

discharge considerations

provide summary
when to expect lab results
future appt
strangulation instructions
resources and contact info

domestic abuse

pattern of coercive, controlling behavior
context of relationship
chose by perpetrator to enforce their position of power
instilling fear
denying victims personal liberty

why

substance abuse
mental illness
"victim must like it/can't be that bad"
the abuser had a bad childhood
anger management
stress, low self-esteem, poor communication, lack of conflict resolution
mutual abuse

strangulation

death and injury due to lack of oxygen to the body --- asphyxiation

choking

internal blockage of the esophagus or trachea preventing airflow

smothering

mechanical obstruction of airflow into the nose or mouth, drowning

postural asphyxia

external limitation of chest movement

traumatic asphyxia

mechanical cause -- blunt force trauma and external compression

hypoxia

low levels of oxygen in body tissues
inadequate delivery or uptake of oxygen to or by tissues

asphyxia

inadequate oxygen supply to the tissues
injuries or blockages

biochemistry

decreased pO2
increased pCO2
decreased pH
increased glucose
decreased Na
increased K

methods

ligature
hanging
manual

hanging strangulation

person is suspended w rope/cord around neck which constricts due to gravitational pull of own body weight

manual strangulation

97%
pressure is applied with hands or other body aprts

factors impacting strangulation

exact location of applied force
quantity of applied force
duration of applied force
surface are of applied force

bilateral jugular vein occlusion

lateral neck
4.4 lbs pressure for 120 seconds
gradual back up of blood in the brain creating stagnant hypoxia

bilateral carotid artery occlusion

anterior neck
11 lbs pressure for 7-10 seconds
direct pressure on the carotid sinuses causes drop in bp, bradycardia, and other arrhythmias
hypoxic and anoxic brain injury death

death

1-2.5 mins strangulation
4-5 mins drowning and suffocation

vision changes

complete loss
black and white
stars
blurry
darkness
tunnel

breathing changes

diff breathing
hypervenitlation
unable to breath
pulmonary edema
worsening of pre-existing conditions

throat and voice changes

trouble swallowing
painful swallowing
drooling
throat clearing/coughin
laryngeal injury/swelling/bleeding
loss of voice

neck pain and external findings

soft tissue swelling
torn/strained muscles, ligaments, tendons
ligature marks
abrasions, bruises, erythema
patterned injuries
self-inflicted defensive wounds

neck edema

subcutaneous emphysema (tracheal/laryngeal rupture)
vessel injury - rips or tears to carotid arteries (hemorrage, clots, leading to stroke)
internal bleeding - to neck, body, brain

neuro changes

headache
LOC
seizure
NV
incontinence
dizziness
weakness, facial droop, trouble speaking, loss of balance/coordination
ASD/PTSD
amnesia

LOC

loss of memory
standing up one min, on the floor the next
bowel or bladder incontinence
witness

amygdala

creating memories by attaching emotions to them
fear
anxiety
happiness
anger

behavioral changes

restlessness
combativeness
agitation

hearing changes

complete/partial loss of hearing
ringing
buzzing
popping
pressure
tunnel-like hearing

thoughts during

disbelief
belief
primal
resignation

pregnant pt

decreased fetal movement
vaginal bleeding
abdominal pain
contractions

follow up visit

strangulation reeval
photos
documentation
discharge
referrals
resources

consequences

swelling
hematomas
vocal cord immobility
displaced laryngeal fracture
fractured hyphoid bone
airway obs
TBI
stroke
malnutrtion
delayed death
resp complications
miscarriage
aspiration pneumonia
thyroid issues
parkinsons

children anatomical differences

bigger head
- higher risk for neck flexion
- higher risk for violent head movement
weaker neck muscles
higher risk for injury
less pressure to occlude

children trachea

smaller in diameter and shorter
pharynx smaller
larynx is more superior and anterior
epiglottis larger and floppy
narrower and less rigid