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Perform a skeletal survey to evaluate for other fractures or dislocations
4%
136/3226
Question the patient in private about the specific details of this injury and her sense of safety in the home
82%
2641/3226
Refer the patient to a nutritionist given the patient’s BMI of 18.8
7%
224/3226
Obtain additional laboratory studies and admit the patient to the hospital for treatment of anorexia nervosa
5%
160/3226
Obtain advanced imaging of the shoulder to evaluate for underlying pathologic lesions
1%
26/3226
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While this patient may have a perfectly reasonable explanation for her current injury, it is imperative for health care providers to inquire into the safety of the home environment in potential cases of intimate partner violence (IPV). Risk factors for female victims IPV include being in the 2nd or 3rd decade of life, current pregnancy, having 1 or more prior children, and low socioeconomic status. Reporting requirements for adult abuse are not standardized amongst most states and physicians must understand the importance of identification and documentation in cases of suspected IPV. Bhandari et al. state that musculoskeletal injuries are the second most common form of IPV (28%) after head and neck injuries (40%). Musculoskeletal injuries can be variable, including sprains, fractures, dislocations, and foot injuries. Della Rocca et al. conducted a survey and found orthopaedic surgeons have several misconceptions regarding victims of IPV and further, nearly half of their survey respondents reported identifying a victim of IPV while only 4% reported that they currently screen their injured female patients for IPV. Zillmer presents a review of the issues surrounding IPV including proper identification, documentation, appropriate questioning and how to involve community services. Illustration A shows some basic facts regarding IPV during pregnancy as reported by the CDC. Additional information can be found at the following link. http://www.cdc.gov/reproductivehealth/violence/IntimatePartnerViolence/index.htm Incorrect Answers: Answer 1. There is no indication for a skeletal survey and it would be inappropriate to subject this pregnant patient to additional radiation. Answer 3. There is no need to refer a patient to a nutritionist for a normal BMI Answer 4. There is no indication for admission or other laboratory studies in this otherwise healthy patient. Answer 5. There is no need for advanced imaging in the emergency department in the case of an isolated traumatic shoulder dislocation
2.1
(47)
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