Medical
Medical Emergencies
■ Pain Assessment
5-Point Pain Scale
Appearance
Pain Level No Pain Mild Pain Moderate Severe Overwhelming
Pain Pain Pain
Score 0 1 2–3 4 5
■ Abdominal
lung heart
diaphragm spleen
liver
kidney
gall bladder stomach
kidney
LUQ
RUQ
pancreas
large intestine
small intestine
RLQ LLQ
ovary
appendix uterus
bladder
,Abdominal Pain—Common Causes
■ Epigastric: AMI, gastroenteritis, ulcer, esophageal disease,
heartburn
■ LUQ: gastritis, pancreatitis, AMI, pneumonia
■ LLQ: ruptured ectopic pregnancy, ovarian cyst, PID, kidney
stones, diverticulitis, enteritis, abdominal abscess
■ RLQ: appendicitis, ruptured ectopic pregnancy, enteritis,
diverticulitis, PID, ovarian cyst, kidney stones, abdominal
abscess, strangulated hernia
■ RUQ: gallstones, hepatitis, liver disease, pancreatitis,
appendicitis, perforated duodenal ulcer, AMI, pneumonia
■ Midline: bladder infection, aortic aneurysm, uterine
disease, intestinal disease, early appendicitis
■ Diffuse pain: pancreatitis, peritonitis, appendicitis,
gastroenteritis, dissecting or rupturing aortic aneurysm,
diabetes, ischemic bowel, sickle cell crisis
■ Abuse
Intentional Trauma
Remove patient from the environment. Report possible
abuse to police, ED staff, and child welfare office. Call for
police assistance if needed to remove patient from the
scene. Do not confront the alleged abuser. Document
your findings and any statements made by child, parent, or
others. Provide medical care as needed. If sexual abuse, do
not allow patient to wash.
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126
Child Maltreatment
Hx—Any unusual MOI, or one that does not match the
child’s injury or illness. Parents may accuse the child of
hurting himself/herself or may be vague or contradictory in
providing Hx. There may be a delay in seeking medical care.
The child may not cling to mother. Fx in any child <2 yo;
multiple injuries in various stages of healing or on many
parts of the body; obvious cigarette burns or wire marks;
malnutrition; insect infestation, chronic skin infection, or
unkempt patient.
Intimate Partner Violence
Repeated ED visits, with injuries becoming more severe
with each visit; minimizing the seriousness or frequency
of the injuries; seeking treatment ≥1 day after the injury;
injuries that are not likely to have been caused by the
incident reported; overprotective significant other who
does not allow the patient to be alone with the healthcare
professional; fractures in different stages of healing
according to radiographic findings; history of child abuse
to patient or partner.
Older Adult Maltreatment
Fractures or bruises at various stages of healing;
unexplained bruises or cigarette burns on the torso or
extremities; soft tissue injuries from signs of restraint use;
head injuries; malnourishment, listlessness, dehydration
unexplained; poor hygiene, inappropriate clothing;
decubitus ulcer, urine and feces on body and clothing;
unusual interaction between caregiver and patient.
Medical Emergencies
■ Pain Assessment
5-Point Pain Scale
Appearance
Pain Level No Pain Mild Pain Moderate Severe Overwhelming
Pain Pain Pain
Score 0 1 2–3 4 5
■ Abdominal
lung heart
diaphragm spleen
liver
kidney
gall bladder stomach
kidney
LUQ
RUQ
pancreas
large intestine
small intestine
RLQ LLQ
ovary
appendix uterus
bladder
,Abdominal Pain—Common Causes
■ Epigastric: AMI, gastroenteritis, ulcer, esophageal disease,
heartburn
■ LUQ: gastritis, pancreatitis, AMI, pneumonia
■ LLQ: ruptured ectopic pregnancy, ovarian cyst, PID, kidney
stones, diverticulitis, enteritis, abdominal abscess
■ RLQ: appendicitis, ruptured ectopic pregnancy, enteritis,
diverticulitis, PID, ovarian cyst, kidney stones, abdominal
abscess, strangulated hernia
■ RUQ: gallstones, hepatitis, liver disease, pancreatitis,
appendicitis, perforated duodenal ulcer, AMI, pneumonia
■ Midline: bladder infection, aortic aneurysm, uterine
disease, intestinal disease, early appendicitis
■ Diffuse pain: pancreatitis, peritonitis, appendicitis,
gastroenteritis, dissecting or rupturing aortic aneurysm,
diabetes, ischemic bowel, sickle cell crisis
■ Abuse
Intentional Trauma
Remove patient from the environment. Report possible
abuse to police, ED staff, and child welfare office. Call for
police assistance if needed to remove patient from the
scene. Do not confront the alleged abuser. Document
your findings and any statements made by child, parent, or
others. Provide medical care as needed. If sexual abuse, do
not allow patient to wash.
125
Medical Medical Medical Medical Medical
, Medical Medical Medical Medical Medical
126
Child Maltreatment
Hx—Any unusual MOI, or one that does not match the
child’s injury or illness. Parents may accuse the child of
hurting himself/herself or may be vague or contradictory in
providing Hx. There may be a delay in seeking medical care.
The child may not cling to mother. Fx in any child <2 yo;
multiple injuries in various stages of healing or on many
parts of the body; obvious cigarette burns or wire marks;
malnutrition; insect infestation, chronic skin infection, or
unkempt patient.
Intimate Partner Violence
Repeated ED visits, with injuries becoming more severe
with each visit; minimizing the seriousness or frequency
of the injuries; seeking treatment ≥1 day after the injury;
injuries that are not likely to have been caused by the
incident reported; overprotective significant other who
does not allow the patient to be alone with the healthcare
professional; fractures in different stages of healing
according to radiographic findings; history of child abuse
to patient or partner.
Older Adult Maltreatment
Fractures or bruises at various stages of healing;
unexplained bruises or cigarette burns on the torso or
extremities; soft tissue injuries from signs of restraint use;
head injuries; malnourishment, listlessness, dehydration
unexplained; poor hygiene, inappropriate clothing;
decubitus ulcer, urine and feces on body and clothing;
unusual interaction between caregiver and patient.
