Alert Never use plastic bags because secretions and seminal stains will mold, destroying valuable evidence.
Tell the victim she may urinate, but warn her not to wipe or otherwise clean the perineal area. Stay with her, or ask a counselor to stay with her, throughout the examination.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Hearing loss:
Signs and symptoms
(Handbook of Diseases)
The four types of hearing loss have different signs and symptoms:
❑ Although congenital hearing loss may produce no obvious signs of hearing impairment at birth, a deficient response to auditory stimuli generally becomes apparent within 2 to 3 days of birth. As the child grows older, hearing loss impairs speech development.
❑ Sudden hearing loss may be conductive, sensorineural, or mixed, depending on its cause. Associated clinical features depend on the underlying cause.
❑ Noise-induced hearing loss causes sensorineural damage, the extent of which depends on the duration and intensity of the noise. Initially, the patient loses perception of certain frequencies (around 4,000 Hz) but with continued exposure eventually loses perception of all frequencies.
❑ Presbycusis usually produces tinnitus and the inability to understand the spoken word.
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Source: Handbook of Diseases, 2003
Wounds, open trauma:
Signs and symptoms
(Handbook of Diseases)
In all open wounds, assess the extent of injury, vital signs, level of consciousness (LOC), obvious skeletal damage, local neurologic deficits, and general patient condition. Obtain an accurate history of the injury from the patient or witnesses, including such details as the mechanism and time of injury and any treatment already provided. If the injury involved a weapon, notify the police.
Also assess for peripheral nerve damage — a common complication in lacerations and other open trauma wounds, as well as for fractures and dislocations. Signs of peripheral nerve damage vary with location as follows:
❑ radial nerve — weak forearm dorsiflexion, inability to extend thumb in a hitchhiker’s sign
❑ median nerve — numbness in tip of index finger; inability to place forearm in prone position; weak forearm, thumb, and index finger flexion
❑ ulnar nerve — numbness in tip of little finger, clawing of hand
❑ peroneal nerve — footdrop, inability to extend the foot or big toe
❑ sciatic and tibial nerves — paralysis of ankles and toes, footdrop, weakness in leg, numbness in sole.
Most open wounds require emergency treatment. In those with suspected nerve involvement, however, electromyography, nerve conduction, and electrical stimulation tests can provide more detailed information about possible peripheral nerve damage.
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Source: Handbook of Diseases, 2003
Rape trauma syndrome:
Signs and symptoms
(Handbook of Diseases)
A physical examination (including a pelvic examination by a gynecologist) will probably show signs of physical trauma, especially if the assault was prolonged. Depending on specific body areas attacked, a patient may have a sore throat, mouth irritation, difficulty swallowing, ecchymoses, or rectal pain and bleeding.
If additional physical violence accompanied the rape, the victim may have hematomas, lacerations, bleeding, severe internal injuries, or hemorrhage, and if the rape occurred outdoors, she may suffer from exposure. X-rays may reveal fractures. The patient may have injuries severe enough to require hospitalization.
Assessment
❑ When a rape victim arrives in the emergency department, assess her physical injuries. If she isn’t seriously injured, allow her to remain clothed and take her to a private room where she can talk with you or a counselor before the necessary physical examination.
❑ Immediate reactions to rape differ. The patient may experience crying, laughing, hostility, confusion, withdrawal, or outward calm; in many cases, anger and rage don’t surface until later. During the assault, the victim may have felt demeaned, helpless, and afraid for her life; afterward, she may feel ashamed, guilty, shocked, and vulnerable, and have a sense of disbelief and lowered self-esteem.
❑ Offer support and reassurance. Help her explore her feelings; listen, convey trust and respect, and remain nonjudgmental. Don’t leave her alone unless she asks you to.
❑ Being careful to upset the victim as little as possible, obtain an accurate history of the rape, pertinent to physical assessment.
CLINICAL TIP: Make sure your documentation is thorough. Your notes may be used as evidence if the rapist is tried.
❑ Record the victim’s statements in the first person, using quotation marks. Also, document objective information provided by others.
❑ Never speculate as to what may have happened or record subjective impressions or thoughts.
❑ Include in your notes the time the victim arrived at the hospital, the date and time of the alleged rape, and the time the victim was examined. Ask the victim whether she’s allergic to penicillin or other drugs, whether she has recently been ill (especially with venereal disease), or whether she was pregnant before the attack. Also ask the date of her last menstrual period and details of her obstetric-gynecologic history.
❑ Thoroughly explain the examination she’ll have, and tell her that it’s necessary to rule out internal injuries and obtain a specimen for venereal disease testing. Obtain her informed consent for treatment and for the police report. Allow her some control, if possible — for example, ask her whether she’s ready to be examined or if she’d rather wait a bit.
❑ Before the examination, ask the victim whether she douched, bathed, or washed before coming to the hospital. Note this on her chart. Have her change into a hospital gown, and place her clothing in paper bags. (Never use plastic bags, because secretions and seminal stains will mold, destroying valuable evidence.) Label each bag and its contents.
❑ Tell the victim she may urinate, but warn her not to wipe or otherwise clean the perineal area. If the patient wishes, ask a counselor to stay with her throughout the examination. This examination is typically very distressing for the rape victim. Reassure her and allow her as much control as possible.
❑ Throughout the examination, provide support and reassurance, and carefully label all possible evidence. Before the victim’s pelvic area is examined, take vital signs, and if the patient is wearing a tampon, remove it, wrap it, and label it as evidence.
❑ During the examination, make sure all specimens collected, including those for semen and gonorrhea, receive careful labeling. Include the patient’s name, the physician’s name, and the location from which the specimen was obtained. List all specimens in your notes.
❑ If the case comes to trial, specimens will be used for evidence, so accuracy is essential. Most emergency departments have “rape kits” with containers for specimens. Carefully collect and label fingernail scrapings and foreign material obtained by combing the victim’s pubic hair; these also provide valuable evidence. Note to whom these specimens are given.
GENDER INFLUENCE: For a male victim, be especially alert for injury to the mouth, perineum, and anus. Obtain a pharyngeal specimen for a gonorrhea culture and rectal aspirate for acid phospate or sperm analysis.
❑ Photographs of the patient’s injuries will also be taken. This may be delayed for a day or repeated when bruises and ecchymoses are more apparent.
❑ Most states require hospitals to report rape. The patient may not press charges and may not assist the police. If the patient doesn’t go to the hospital, she may not report the rape.
❑ If the police interview the patient in the hospital, be supportive and encourage her to recall details of the rape. Your kindness and empathy are in-valuable.
❑ The patient may also want you to call her family. Help her to verbalize anticipation of her family’s response.
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Source: Handbook of Diseases, 2003
Noise-Induced Hearing Loss as a Cause of Symptoms or Medical Conditions
When considering symptoms of Noise-Induced Hearing Loss, it is also important to consider Noise-Induced Hearing Loss as a possible cause of other medical conditions.
The Disease Database lists the following medical conditions that Noise-Induced Hearing Loss may cause:
- (Source - Diseases Database)
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