Abuse and Assault PDF

1 2  Partner Abuse  Elder Abuse  Child Abuse  Sexual Assault  Date Rape Drugs 3  Nearly three million children are abused each year.  More than 1,000 die every year.  Two to four million women are battered each year (Only 10% of women report battering incidents)...

1 2  Partner Abuse  Elder Abuse  Child Abuse  Sexual Assault  Date Rape Drugs 3  Nearly three million children are abused each year.  More than 1,000 die every year.  Two to four million women are battered each year (Only 10% of women report battering incidents).  700,000 to 1.1 million elderly people are abused every year. 4  Victims may: die suffer mental or physical injuries 5 6  Men, women who beat one another also most likely beat their children  Children of abusive, unloving homes more likely to become spouse, child, elder abusers 7  Prevention strategies Early detection Social services support Altering life styles 8 9  Physical or emotional violence from men or women toward their domestic partners or others 10  Fear of reprisal  Fear of humiliation  Denial  Lack of knowledge  Lack of financial resources 11 12  Physical  Verbal  Sexual 13  *Abuse may exacerbate existing medical conditions. 14  Pregnancy  Substance abuse  Emotional disorders 15  Male is unemployed  Male uses illegal drugs at least once a year  Partners have different religious backgrounds  Family income is below the poverty level  Partners are unmarried 16  Either partner is violent toward children at home.  Male did not graduate from high school.  Male is unemployed or has a blue- collar job.  Male is between 18 and 30 years old.  Male saw his father hit his mother 17  Use direct questions.  Avoid judgments.  Listen carefully.  Encourage patients to regain control of their lives.  Offer knowledge of community resources.  Advise the patient to take all necessary precautions before returning home. 18 19  Domestic  Institutional 20 21 22  The most common cases involve elderly women abused by their sons.  Most frequently occurs among people who are dependent upon others for their care.  In cases of neglect, abused elders most commonly live alone 23 24 *Child abuse can occur from infancy to age 18 y. and can be inflicted by any number of caregivers. 25 26  3,000,000 cases/year  > 1,000 fatalities  10% of trauma < 3 years old seen in ERs  All social, economic, religious, ethnic groups 27  Contributing Factors: Child “Different”: handicapped, hyperactive, precocious Male > Female 2:1 Small enough to be unlikely to retaliate 2/3 of abused children are < 3 years old 28  Use or abuse of drugs and/or alcohol  Immaturity and preoccupation with self  Lack of obvious feeling for the child, rarely looking at or touching the child  Seemingly unconcerned about the child’s injury, treatment, or prognosis  Little identification with the child’s pain  Often abused themselves as children  Lonely, unhappy, under stress  Lack of understanding of normal child development 29  Crying, often hopelessly, or not crying at all, during treatment  Avoiding the parents or showing little concern for their absence  Unusually wary or fearful of physical contact  Apprehensive and/or constantly on the alert for danger  Prone to sudden behavioral changes  Absence of nearly all emotions  Neediness, constantly requesting favors, food, or things 30  Child is: Apathetic Unusually stoic Extremely fearful of adults Unusually loving or cooperative 31  *A child’s behavior is one of the most important indicators of abuse. 32  Multiple or repeated injuries Unusual variety Different stages of healing Unusual locations  Inconsistency of injury with: Reported mechanism History Developmental abilities 33  History changes on retelling  Multiple ER visits, EMS contacts  Inappropriate parental response Prolonged delay in seeking help Parent hostile, indifferent, apathetic Person other then caretaker brings child in  Malnutrition  Poor hygiene  Inappropriate dress 34 35  *Soft-tissue injuries are common indicators of abuse, especially multiple bruises in different places on the body, in different stages of healing, and/or with distinctive shapes. 36  Burns and scalds  Fractures  Head injuries  Shaken baby syndrome  Abdominal injuries 37 38 39 40  Malnutrition  Severe diaper rash  Diarrhea or dehydration  Hair loss  Untreated medical conditions  Inappropriate, dirty, or torn clothing  Tired or listless attitudes  Nearly constant demands for physical contact or attention 41 As with all other forms of abuse, paramedics have an obligation to report suspected child abuse. 42 43  Sexual assault—unwanted oral, genital, or manual sexual contact  Rape—penile penetration of the genitalia without the consent of the victim 44  Symptoms of sexual abuse, regardless of its form, may include: ¤ Nightmares ¤ Restlessness ¤ Withdrawal tendencies ¤ Hostility ¤ Phobias related to the offender ¤ Regressive behavior, such as bed wetting ¤ Truancy ¤ Promiscuity, in older children and teens ¤ Drug and alcohol abuse 45 46  Render a person unresponsive.  Weaken them to a point where they are unable to resist an attacker.  Some of these medications cause amnesia, thus eliminating or distorting the victim’s recall of the assault. 47  Flunitrazepam  Characteristics  A benzodiazepine  Colorless marketed in Mexico,  Odorless South America  Used for insomnia  Tasteless  10 times more potent  Can be dissolved in a than valium drink without being  Effects in 20 minutes detected  Duration up to 8 hours  Alcohol intensifies effects 48  CNS Depression  Amnesia  Respiratory depression  Muscle relaxation 49  Like GABA (Gabapentin is used in epilepsy,  Characteristics peripheral neuropathic  Liquid pain)  Odorless  Like alcohol  Colorless  Effect in 15–30 minutes  Duration 3 hours  Used as an amino acid supplement by body builders  Depressant with anesthetic-type qualities 50  Relaxation  Tranquilizer  Sensuality  Loss of inhibitions 51  Ketalar  Used as an anesthetic  Characteristics  10 times more potent  Potent anesthetic than Valium agent with dissociative  Hallucinogenic effects effects last 45–90 minutes  Duration up to 24  Colorless, odorless hours liquid  Widely used in  White veterinary practice  Off-white powder  Used in human anesthesia 52  Hallucinations  Delirium  Amnesia  Dissociation  Respiratory depression  Seizures  Arrhythmias  Cardiac arrest  Hypertension 53  One of most abused  Characteristics amphetamines by  10% the stimulant teenagers/college effect of students amphetamines  Large dose = same  Potent serotonin effects as release amphetamines  Effects:  Temperature is a key  Onset within 20–60 finding minutes  2–3 hour duration 54  Psychological  Physical  Mood alteration,  MI, dysrhythmias, sleep, anxiety CVA  Poor memory, poor  Seizures impulse control  Serotonin syndrome  Use of other drugs  Permanent damage  Tolerance to serotonin neurons  Hyperthermia 109° 42.8°C 55 56 *Your actions in the case of alleged sexual assault can affect the prosecution of a crime. Protect the evidence! 57  Anything that can be used to connect: A victim to a suspect A suspect to a victim A suspect to the crime scene 58  Legally retaining items of evidence and accounting for their whereabouts at all times to prevent loss or tampering 59  Patient care is the FIRST priority of ALL responding agencies  The most important part of evidence collection is protecting the crime scene  Be aware that anything on or around the patient may be considered evidence.  Whenever in doubt, save or treat an object as evidence.  Develop an awareness of evidence.  Record only the facts at the scene of a crime, and record them accurately. 60  Victims of alleged sexual assault should not wash or use restroom until they are examined at hospital  If victim reports scratching assailant, cover victim’s hands with paper bags; tape loosely at the wrists 61  *In calls involving abuse or assault, your primary responsibility is safety—both your own and that of your patient. 62