techniques for young patients.ppt handoutdepts.washington.edu/hcsats/training/core_sane... ·...
TRANSCRIPT
Why are children different?
• Often no verbal report, or only vague report
• Interpretation of statements may be biased• Time of contact uncertain
Why are children different?
• Bathed before exam• Long time before exam• Exam may be distressing to child• Orifice swabs may be painful
Purpose of the acute exam
• TO:• Identify Acute
injury• Diagnose other
conditions(If in your scope of practice)
• Collect forensic evidence
• NOT:– Identification of
healed injury– Determine if
abused has ever occurred
– Make the child uncomfortable
Do
• Talk to the parent alone – listen to their concerns• Introduce your self to the child they should know
who you are and what you do• Help the child relax before the exam• Provide simple explanation of exam (i.e. we are
going to check your whole body from your head to you toes) to both parent and child
Do’s Continued
• Explain the parent’s role in the exam, one of support to the child, distraction for the child and that you will tell them all about the exam after it is done.
• Allow the child to check out the equipment • Assure the child that we check all children this
way • Allow questions both for the child and parent• Proceed at the child’s pace
Do’s Continued
• Provide distractions for the child-view master, bubbles, singing
• Reassure the child and the parent that there is no serious or permanent injury
• Inform the parent that you cannot come to a conclusion about abuse or not from the exam alone.
• BE FLEXIBLE
Don’t
• Don’t force an exam with an unwilling child• Don’t hurt the child – the exam should
never be worse than the abuse• Don’t insert swabs into a pre or early
pubertal child’s vagina- it can really be painful
• Don’t rush to exam conclusions- most findings can have different diagnoses
GENITAL EXAMINATION TECHNIQUES
• Labial separation• Labial traction• Downward traction• Prone knee-chest• Options for frog-leg or stirrups
Prone knee chest position
BleedingDifferential Diagnosis
• Trauma– Straddle– Impalement– Abuse
• Vaginitis• Vaginal foreign body• Dermatitis• Lichen sclerosis
• Urethral prolapse• Hematuria• Genital warts• Tumor
– Vaginal sarcoma• Anal blood
– Fissure– Colitis
• Shigella, salmonella
MALE GENITAL STRUCTURES TO OBSERVE AND DESCRIBE
• Pubic area and inguinal nodes• Penis• Urethral meatus• Scrotum
MALE NORMAL ANATOMIC VARIANTS
Examples:–Prominent frenulum–Pearly pink penile papules–Hemangiomas
EVALUATION OF THE ANUS
• External inspection sufficient• Use of magnification helpful• Digital examination or insertion of
instrument or scope RARELY needed• Positions: KCP, legs raised, decubitus
Anal and Perianal Findings to Note
• Pigmentation• Tags, hemorrhoids• Venous engorgement• Diastasis Ani• Sphincter tone• Rugal pattern
Anal traumaDifferential diagnosis
• Venous congestion• Normal anal dilitation• Visible mucosa• Anal fissures• Perianal strep• Inflicted trauma• Failure of Midline Fusion• Perineum and median raphe