Child abuse....please check me! - forever07

[ArchivalUser]

Hi

Is this order correct for child abuse.

1. Lab studies,...pt,ptt,ptl,bleeding time

2, skeletal survey, eye exam, ct head in abdominal trauma, ct abdo in abdo trauma

3, report CPS

4, admit

Do u agree with me?

[ArchivalUser]

Should we admit first and then do the workup to avoid the possible abusive environment for the child? Labs, imaging can be done while in the hospital. It makes sense to me.

[ArchivalUser]

yes I think its better to admit and then run tests.

[ArchivalUser]

But in real, we don't admit child directly from ER without knowing DX, kid can also be other medical problem, right?

Can u please check MTB 344,

Always address medical and or surgical issue.

Some people said report CPS....

So? What do u think?

[ArchivalUser]

Unless the outpatient setting is an urgent care where you can do xrays and labs right there and then, in a regular clinic, the results aren't available for a few days, the child may be in danger in child abuse case in the meantime while waiting for you to come up with a diagnosis. I would rather be safe than sorry. Also in an inpatient setting, you can hand over the case to a social worker more easily in case of child abuse.

The reason you suspect child abuse in the first place is all the clues in the history, you do labs/imaging studies to confirm or rule out other medical disorders. So why risk it and the kid may be in danger?

[ArchivalUser]

For CCS case,

So you mean , after Physical exam, u suspect of child abuse and then are you going to change the location to ward directly?

You don't want to order lab test and imaging in ER? Why not?

If you do in ER, your result will come out earlier than if you do in ward.

Agree?

[ArchivalUser]

I agree with Forever,as thts what UW says.....

I think u shud order these tests in office as soon as the child comes to rule out medical causes which might mimic as abuse, consult CPS and then transfer the child to the ward.

According to UW

Complete P/E------> cbc, pt,ptt,bt, skeletal survey STAT, CPS STAT----> Transfer the child to the ward---> and advance the clock to obtain CPS recommendation......

[ArchivalUser]

Gainer..you agree with sequence, thanks

Rock...do you agree? These sequence are the same for CCS and MCQ.

[ArchivalUser]

There is a miscommunication here somewhere.

forever07, I thought you meant if the patient presented to an outpatient clinic, then I would have the patient go to ER. But if the patient presents in ER, then definitely do labs/imaging, consult with social worker, then admit. I'm sorry for the misunderstanding.

gainer84, fyi, you cannot send the patient from outpatient clinic directly to the ward, they must go through ER first, then ER will decide to admit to ward or not. While in ER, labs/imaging can be ordered.

[ArchivalUser]

Oh no, you can admit from out pt clinic to Ward directly, but not to ICU.

If you need to admit the pt to ICU from out pt clinic, you must shift the patient to ER then to ICU.