Abuse/Partner Violence/Forensic Flashcards

1. Slap marks
2. Looped or flat contusions from belts
3. Circular contusions from finger tips
4. Parallel contusion with central clearing (eg. hit with stick)
5. Patterned contusion (shoe /tennis racket)
6. Bite marks/scratch

1. Superficial to trunk, arms, face
2. Parallel incisions on the non-dominant side of body
3. Sparing sensitive areas
4. Intact clothing over wound
5. Prior wounds healed
6. Linear or curved wounds towards dominant hand

1. Unexplained delay in seeking medical attention
2. History is not consistent with time
3. History is not consistent with mechanism
4. History is not consistent with developmental abilities
5. Child has “magical” injuries

1. Long bone fractures
2. Non-linear skull fractures
3. Posterior rib fractures
4. Multiple fractures in various stages of healing
5. Classic Metaphyseal Injury
6. Spinous process fracture

Skeletal Survey Indication

• Age <2 with suspected inflicted injuries
• Includes x-rays of skull, long bones, ribs, vertebrae
• Multiple fractures in various stages of healing
• If high index of concern despite normal skeletal survey, repeat in 2 weeks or order a bone scan

1. Accidental trauma
2. Birth trauma (occult skull #s)
3. Osteomalacia of prematurity
4. Osteogenesis imperfecta
   * Congenital disorder of collagen
   * Blue sclerae, hearing loss, short, brittle bones
5. Ricketts (Vitamin D or Calcium Deficiency or Hyper PTH)
6. Scurvy (Vitamin C Deficiency)
7. Hyperparathyroidism
8. Juvenile Osteoporosis
9. Pathologic #’s
10. Menke’s disease
    * X-linked recessive disorder –> copper deficiency
    * Weak bones, developmental delay, sz, hypotonia
11. Congenital syphilis
12. Congenital rubella

1. Foreign body
2. STI, sexual abuse
3. Pinworms
4. Shigella infection
5. GAS infection
6. Candida
7. Irritant/allergic vaginitis (bubble bath)

1. Explain who you are
2. Leave tough questions to the end
3. Quiet safe confidential place
4. Advocate
5. Offer to have chaperone present

Toluidine Blue

• Nuclear stain that has been shown to enhance gross visualization of external genital (vulvar) injuries
• Has some spermicidal activity but shown in one study not to influence DNA analysis
• Stain results depend on the presence or absence of nucleated cells

Positive results:

• Trauma
• Cancer
• Inflammation

Gonorrhea

• Cefixime 800 mg PO in a single dose OR
• Ciprofloxacin 500 mg PO in a single dose
• if low resistance in community; test for cure needed
• If pregnant: Cefixime 800 mg PO in a single dose

Chlamydia

• Azithromycin 1 g PO in a single dose
• Doxycycline 100 mg PO bid for 7 days
• Pregnant adults: Azithromycin 1 g PO

Trichomoniasis

• Metronidazole 2g PO single dose
• only if proven Trich, not empiric!

Step 1

• Check immunization status
• If immune, stop
• If not, go to Step 2

Step 2

• Hep B vaccine for all (0, 1, 6 months)
• HBIg 0.06 mL/kg IM x1 within 48h for sexual assault
• May be given up to 14d, but less efficacious
• Indicated for vaginal, rectal, and anal-oral contact

Within 72h:

1. Plan B - Levonorgestrel 1.5 mg
2. Copper IUD

1. <72 hours
2. LoC
3. Altered
4. Suspicion

• No LoC or voice change: No imaging
• LoC : CT/CTA
• Voice changes: CTA + Fibreoptic laryngoscopy

Components of History:

• Patient history (past medical history, last intercourse)
• Assault history (where, when, who)
• Methods used (choking, weapons)
• Post-assault activity (shower, eat, drink)
• Assault acts (oral, anal, ejaculation)

1. Gonorrhea
2. Chlamydia
3. Trichomonas
4. HIV
5. Hep B
6. Tetanus
7. Pregnancy