Augmented ED

Augmented ED

The future of emergency medicine?

EPs in Rhode island overcome hurdles to trial Glass for telemedicine and consider other applications.

All About Metoclopramide (Reglan)

All About Metoclopramide (Reglan)

Know the risks

Reglan should be used with caution if patients have Parkinson’s disease or are on antipsychotics.

Physicians Won't Be Silenced

Physicians Won't Be Silenced

ACEP's Gag Order Rejected

EPM readers speak out against ACEP’s new ruling prohibiting incoming leaders from answering questions from non-ACEP publications.

Changemaker

Changemaker

How One EP Transformed Mental Health Admissions in Virginia

Debra Perina combined her experience as a coroner with her time leading an ED to challenge the establishment.

Get the Gear Off

Get the Gear Off

Removing the Helmet and Pads is Crucial to Treating Spinal Injuries from Football

Up to 25% of c-spine injuries from football collisions may be exacerbated by the poor removal of helmet and pads.

The War on Death

The War on Death

by Greg Henry, MD

The guns and butter debate is really over, I guess.

The Ebola Plan

The Ebola Plan

CDC Quarantine Map Shows that a U.S. Ebola Outbreak is Unlikely

Amid the worst outbreak of the Ebola virus in recorded history, there have been concerns that the disease could spread…

How Do I Know if I'm Being Paid Fairly?

How Do I Know if I'm Being Paid Fairly?

Trust is key

I get paid based on my productivity, but I don't trust that my company is paying me accurately.

The Stethoscope of the Future

The Stethoscope of the Future

Bedside Ultrasound

The applications of bedside ultrasound have gone well beyond scanning the gallbladder . . . to the lungs?

ICEM 2014

ICEM 2014

Tintinalli Headlines & Holliman Assumes Presidency

On June 11, EPM Editor-in- Chief and renowned educator Judith Tintinalli took to the stage in Hong Kong to address…

The Medical Malpractice Rundown: A State-by-State Report Card

The Medical Malpractice Rundown: A State-by-State Report Card

When it comes to medical liability laws and culture, where you live matters.

Find out how your state stacks up against the other 49.

CT – Lowering Cost and Radiation

CT – Lowering Cost and Radiation

Medicare pays only about 20% of typical charges and radiation can be reduced by 90%.

The cost of a CT is actually quite nominal – the charge, however, is an entirely different matter. 

 Aftermath: The Night Shift Season 1 Finale Review

Aftermath: The Night Shift Season 1 Finale Review

At Loose Ends

It’s strange calling this a season finale, because it’s only been an 8-episode summer run, and nearly every episode has…

Doximity’s Next Trick: Connectivity at the Point of Care

Doximity’s Next Trick: Connectivity at the Point of Care

You’ve raised $81 million in investments and your physician membership now exceeds that of the AMA. What’s next?

If you're Doximity, it's time to dream big. 

Subcutaneous Insulin in DKA: Safe — But Not Better

Subcutaneous Insulin in DKA: Safe — But Not Better

Newer Isn't Always Better

Studies show that the benefits of subcutaneous insulin over old fashioned IV insulin are marginal at best.

A Return to (Lousy) Form: Episode 7 of The Night Shift

A Return to (Lousy) Form: Episode 7 of The Night Shift

Forks! Strippers! Guns!

Once again, our characters are responding to the (frankly unbelievable) events unfolding around them, rather than driving the action.

Oxygen is a Drug— Act Accordingly

Oxygen is a Drug— Act Accordingly

Understanding the dangers of indiscriminate oxygenation in the ED setting

As with many things in medicine, dogma seems to overpower the evidence in this arena. 

Oh Henry: A Sucker is Born Every Minute

Oh Henry: A Sucker is Born Every Minute

Pharmaceutical Ads, Government, and the Physician-Patient Relationship

Though it pains me to say it, this is one time where caveat emptor doesn’t apply. 


Gag Order

Gag Order

New ruling prohibits would-be ACEP leaders from answering questions from non-ACEP publications.

Greg Henry seldom fails to deliver on a promise. But this time, it looks like it’s out of his control.

The Downside of the Upswing

The Downside of the Upswing

You should have cashed in big-time. 
But did you?

The last several years of returns have been among the best ever.

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Domestic violence (DV), also known as intimate partner violence, includes a wide variety of behaviors that are aimed at coercing, controlling, intimidating, or demeaning someone else through physical abuse, social isolation, deprivation, and intimidation. Legal definitions vary but refer to acts of physical or sexual violence. Literature reports yearly incidence of DV ranging from 5 to 11.7% with lifetime prevalence of 21-54%; women were six times more likely to be the victims. Disturbingly, the National Violence against Women Survey found 25% of women and 7.6% of men report rape or physical assault in their lifetime. JCAHO now requires ED protocols to identify and treat DV victims.
Young, single women, as well as pregnant women are particularly at risk for DV. Victims are more likely to be depressed, have low self-esteem and increased stress. There is no consensus concerning if race or socioeconomic status places people at risk. Also, there are no specific universal characteristics of abusers. Substance abuse or exposure to violence as a child is prevalent in abusers according to some studies. Since it can be difficult to distinguish an abuser or a victim, it is very important that the EP screen for DV. Although 37% of female trauma victims presenting to the ED are caused by partner-related DV, studies have shown that EPs only identified 5% of DV victims and only 13% even ask about DV. This is particularly startling since victims of DV report that a question by a health care worker is the essential first step to identifying the problem.
The partner in violence screen has a sensitivity of 65-71% for DV while the StaT test has a sensitivity of 97% (see chart).
 
altOther authors suggest open-ended questions, but since victims rarely volunteer information, attempting to perform some type of screening is more important than the types of questions asked.
Suspicion should be raised with any injury during pregnancy, recurrent injuries, or defensive injuries. Patients may present with vague, non-specific complaints as initially physical injury is less common. The patient may be evasive or fearful during the interview or delay seeking treatment or come in with an overly protective, hovering partner. DV victims present with a 60% higher rate of problems such as headache, back pain, GI problems, depression, substance abuse, eating disorders, and PTSD. Also chronic diseases can be exacerbated or be poorly controlled. Remember a high level of suspicion is important and you need to screen for suicidal ideation.

EPs need to understand the five stages of change in order to help their patient get out of an abusive relationship. In the precontemplation stage the patient may not know they are being abused and does not want to change the situation. In contemplation the victim can gather information but is not actively seeking change. In preparation the victim is planning change. This is followed by the action stage and the maintenance stage where the patient leaves/ends the violence and works to prevent relapse. Knowing the stages is important because making the patient aware of abusive behaviors and reassuring them that DV is not their fault is more effective in the first two phases while referrals, hotlines, and support groups are more effective in the later stages.

Documentation is very important as these records may be needed in a criminal trial. Direct quotes are very useful. Different states also have different laws concerning what must be reported. Also the physician must make sure it is safe before the patient leaves and can give them websites or phone numbers such as 1-800-799-SAFE (National Domestic Violence Hotline).
 
Other DV Sites:
www.ndvh.org
www.endabuse.org
www.ncadv.org
www.nnedv.org/who.html
www.ojp.usdoj.gov/vawo/state.htm
 

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