3. • Unlikely mechanism of injury
– Story does not match injury
• Details of injury change from person to
person
• Multiple injuries in various stages of
healing
4. • Injuries inconsistent with their explanation
• Use of several different health-care
providers or facilities
• Unexcused delay in seeking medical
attention
7. 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
8. • Burns or wire marks
– Scalding, cigarettes
• Fractures or dislocations in a childe less
than 2 years old
• Withdrawn or aggressive behavior
• Malnutrition, insect infestation, disheveled
appearance
9.
10. Sexual Abuse
• Bruised and/or bleeding genitalia or blood-
stained underwear
• Painful urination or itching of genital area
• STD or pregnancy
• Unusual sex bahavior
14. • 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
16. • 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 patient alone with staff
18. • 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
19. • Discourage sexual assault victims from
urinating, bathing, or changing clothes
prior to going to the ED
20. 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.
