Abuse

Signs Consistent with All Forms of Abuse

■ Unlikely mechanism of injury (story does not match injury).

■ Details of injury change from person to person.

■ Multiple injuries in various stages of healing.

■ Injuries inconsistent with their explanation.

■ Use of several different health-care providers or facilities.

■ Unexcused delay in seeking medical attention.

Signs of Child Abuse

Physical Abuse:

■ History is inconsistent with child’s developmental stages.

■ Overly protective parent (interferes with assessment).

■ Unusual fear of parent or desire to please parent.

■ Burns (scalding or cigarettes) or wire marks.

■ Fractures or dislocations in a child less than 2 years old.

■ Withdrawn or aggressive behavior.

■ Malnutrition, insect infestation, or disheveled appearance.

Sexual Abuse:

■ Bruised and/or bleeding genitalia or blood-stained underwear.

■ Painful urination or itching of genital area.

■ STD (sexually transmitted disease) or pregnancy.

■ Unusual sexual behavior.

Signs of Elder Abuse

■ Malnourishment and unexplained dehydration.

■ Poor hygiene (body and clothing soiled with urine and feces).

■ Clothing inappropriate for season.

■ Signs of inappropriate use of restraints (wrist and ankle bruises).

Signs of an Abusive Partner

■ Often, battered women will minimize their injuries or the seriousness of the situation.

■ Repeated visits to the ED with increasing severity of injuries.

■ Overprotective partner refuses to leave Pt alone with staff.

Emergency Management

■ Assess and ensure safety for yourself and the victim (call security if alleged abuser is present).

■ Remove victim from abusive environment and treat as indicated.

■ Avoid any confrontation with the alleged abuser.

■ Discourage sexual assault victims from urinating, bathing, or changing clothes prior to going to the ED.

■ It is a health-care provider’s legal obligation to file a report with appropriate authorities or protective services when abuse is either witnessed or suspected.