BCE 65 Intimate Partner Violence – A Silent Epidemic

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 23 January 2018

⏱️ 13 minutes

🔗️ Recording | iTunes | RSS

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Summary

I was taken aback when I came across the statistic that approximately every 6 days a woman in Canada is killed by her intimate partner. Victims of intimate partner violence and domestic violence that we see in the ED typically involve an abuse story of repeated escalating violence over time that ends up in a crisis situation. The woman is often financially dependent on her abuser and has no one to turn to for help. In one of her worst cases ever from Janus General, Dr. Meeta Patel and I discuss the notions that Emergency providers have a unique opportunity to identify patients who are victims of intimate partner violence; that we should begin by thinking of how we can screen every woman of childbearing age about intimate partner violence in a private, safe and respectful way. We describe the quick Partner Violence Screen and finally how to offer supportive, empowering statements and connect your patients with resources like assaulted women’s helpline and shelters in your community...

Transcript

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0:00.0	Best case ever.
0:01.8	Best case ever.
0:09.7	Yes, this is EMK's Best Case Ever mini podcast series, we've got my colleague at North York General Hospital, a rising star in the med ed world, Dr. Mita Patel, who's going to tell us about one of her worst
0:38.9	cases ever on a topic that's received quite a bit of attention recently in the wake of a
0:44.1	murder of a family doctor here in Toronto, allegedly at the hands of her husband. So Dr. Patel,
0:50.0	welcome to EM cases. It's great to have you here. Thank you, Anton. So this is a case of an otherwise
0:56.0	healthy 39-year-old woman. I saw her in the ambulatory area of Janus General ED. It was a late
1:01.7	evening. She came in with the chief complaint of severe right ear pain. She told me that her pain
1:07.5	had started just a couple of hours ago while she was at rest. She said it was a sharp pain, initial tinnitus, some short-lived vertigo, and that had all resolved.
1:16.0	There was no hearing loss.
1:17.8	She also complained of some clear, watery discharge from her ear.
1:20.9	She denied any recent URI symptoms or fever.
1:24.1	I asked her if she'd been scuba diving or flying anything that would change the pressure in her ear, and she hadn't.
1:29.2	She also denied the use of cotton swab tips in her ears. You know, we see all kinds of ear trauma from the evil Q-tip.
1:36.4	I asked her about a history of any other trauma, and again, her answer was no. All the while I was taking her history, I noticed that she never once looked up at me.
1:46.9	She hadn't looked me in the eye. Her eyes had looked a bit welled up and she looked like she'd just
1:52.0	been crying. I had that spiky sense you get where there's something just not right with her story.
1:58.7	On exam, her vitals were normal. She was a febrile. She was cupping her right ear with her
2:03.7	hand and looked like she was in pain. So I took a look at her ear. It looked normal on the outside.
2:08.9	She did have some tug tenderness. Then I looked inside her ear and she had an obvious ruptured
2:13.6	tympanic membrane with a bit of clear fluid draining into the canal. The rest of her head and neck
2:18.6	exam was normal. At this point, I had already began to suspect assault or domestic violence as a cause of her
	...

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