Læknablaðið : fylgirit - 15.06.2002, Blaðsíða 33

POSTERS / ICELAND 2002: EMERGENCY MEDICINE BETWEEN CONTINENTS
the Emergency Department’s (ED) staff. It is a combination of
medical, legal, cultural, and private aspects together.
The ED of Tel Aviv Sourasky Medical Center (TASMC) is a
Level 1 Trauma Center, with about 450-500 ED’s visits about
170.000 visits per year. [1] Among 1200 wounded that were treated
in the Trauma Unit (TU) during the year 2000, the definition of
injuries included blunt trauma, penetrating trauma from road
accidents, work accidents, fallings from heights, burns, attempt
suicides and different assaults. 158 wounded out of the 1200, were
assault victims (13.1%). Among the assault victims:
153 male (96.8%).
5 female (3.16%).
104 of the assault victims were stabbed (65.8%).
45 of the assault victims were beaten (28.5%). Five of the victims
were both stabbed and beaten (3.16%).
9 of the assault victims were shot (5.6%).
61 of the wounded were above 30 years old, including one 67 year-
old (38.6%).
23 of the wounded were of unknown age (14.5%).
27 of the wounded were between 25 and 30 years old (17%).
15 of the wounded were between 21 and 25 years old (9.4%).
16 of the wounded were between 18 and 21 years old (10.12%).
16 of the wounded were under 18 years old (10.12%).[2]
This paper concentrates on the last two groups that together
includes 20.24% of the wounded. They are the groups that include
underage and young up to 21 years of age. In those two groups we
found out that 50% of them used alcohol before the injury [3].
The intervention model based on ED characteristics:
• Shortage of time.
• Involvement of multi-professional staff.
• Partial data collection.
• Medical and psychosocial decisions simultaneously.
• Treatment’s continuation out of the ED.
The model was based on the assumption that comprehensive
care of youth victims of violence requires treating on several levels
at once: medical treatment. legal aspects and social services.
References:
1. Deparlment of Statistic and Admission Office, Tel Aviv Sourasky Medical
Center, 1999.
2. Department of Emergency Medicine, Trauma Unit, Tel Aviv Sourasky Medical
Center, 2000.
3. Shgi B, Kluger Y, 1998, Harefuah- Journal of the Israel Medical Association,
Vol.134, No 11, P 900-902.
P 48 - Domestic / Child Abuse and Rape
A survey of current practices for managing domestic violence
(DV) withín Accident and Emergency Departments
Smith S
Specialist Registrar A&E, John Radcliffe Hospital, Oxford, UK
Introduction: DV is a significant social issue. After an episode of
DV, victims show increased attendance rates to primary care and
emergency departments for non-related conditions. Studies reveal
that only 5% of women are questioned about DV in A&E. The
Department of Health document on DV states health professionals
should be “asking questions routinely” and that protocols should
reflect this universal screening.
Methods: A postal survey was sent to one hundred A&E depart-
ments within the UK. The survey consisted of four questions with
simple positive/negative response options with supplementary
questions attached.
Results: The response rate was 80%. Only 31% routinely screened
for DV. Only 5% had a formal nursing interview for screening in
addition to screening at triage. Of those that had the details of a
DV liaison worker in the department, only 38% had this in a form
which could be given to the patient. As regards protocols for the
management of victims of DV, 22.5% of departments that
responded possessed one. 36% of departments have regular
sessions on DV as part of their staff training.
Discussion: This survey reveals that under one third of A&E
departments routinely screen for DV, and most stated screening was
at triage level, which has previously been revealed to have a low
detection rate. DV also appears to take a low priority in the
educational programmes of the surveyed departments. Improved
detection of DV has been shown to occur after implementation of
formal education programmes. Over three-quarters of departments
have no protocols for the care of victims of DV, which may lead to
inconsistencies. In summary, at present A&E departments are failing
to make attempts to identify and manage DV against women.
P 49 - Ultrasound
A Novel Use of the Endocavity (Transvaginal) Ultrasound Probe:
Central Venous Access in the Emergency Department
Phelan MP
Cleveland Clinic Foundation, Department of Emergency Medicine, Cleveland, Ohio
Vascular access is a vital component of patient care in the emer-
gency department, and obtaining it either peripherally or centrally
is a critical skill for any emergency department physician. When
unable to obtain peripheral IV access, physicians typically place an
IV catheter percutaneously into one of the three large central veins
(the internal jugular, subclavian, or femoral.) This procedure is
performed by many different specialties, each with their own
prejudices and preferences, but one common thread is the use of
surface landmarks for guidance. Such a method poses a problem
when dealing with difficult patients like obese adults or young
children. Ultrasound assisted vascular access, though, provides a
safe and efficient means of obtaining both peripheral and central
venous access. Most emergency departments that already use
ultrasound machines typically have a 3.5 megahertz(MHz) probe
for adult abdominal trauma exams and a 7.5 MHz endocavity probe
for transvaginal exams. A separate, high-resolution 7.5 MHz linear
vascular probe is usually indicated for use in obtaining vascular
access. Since the expense of purchasing a separate vascular probe
can be a burden, this report will describe the use of an endocavity
(transvaginal) probe for vascular access. Since each probe costs
thousands of dollars, the economic value of having one less probe
to purchase may be significant. The use of the slim necked, focal, 7.5
MHz endocavity (transvaginal) ultrasound probe for free hand
vascular access is practical and simple. The easier maneuverability,
readily available sterile cover probe (sterile rubber glove), and
more focused exam over the vein to be accessed makes this a viable
option when considering ultrasound assisted vascular access.
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