teske final

  1. What are second and third
    degree burns?
    Lesions in which there is a complete necrosis (dead) of the epidermis (skin) over the entire target area. Also referred to as a “scald burn”
  2. What distinguished between
    a second and third degree burn?
    The depth of the burn- 2nd is more surfaced and the 3rd burns down deep (muscles, nerves, and tissues) and will not come back so you will either have scar tissue or need a skin graft
  3. What is meant by
    threshold exposure
    The shortest time at any given temp that causes complete destruction of the epidermis
  4. Examples of Threshold
    • 111 degrees is the lowest possible temp for subcutaneous burning and requires 6 hrs-that is, burning below the skin
    • 115 degrees requires 3 hrs
    • 118 degrees requires 15 minutes
    • 155 degrees requires 1 sec or less
    • Exposure to the sun can someone get a 2nd or 3rd
    • degree burn? Yes
    • 140 degrees is the temp at which hot water heaters are normally set
  5. What does the body do to
    compensate for excessive heat at the level of the epidermis?
    Its going to start cooling it and your body will gradually get there unless it’s a very bad case
  6. What is hyperthermia?
    Excessive heat
  7. What is hypothermia?
    Excessive cold
  8. According to Monteleone,
    what is the most common place that burn
    Injuries were recorded?
  9. The most common type of
    • (48% rounded) were scald
    • burns,

    • followed by flame (30%
    • rounded)
  10. What is a stocking burn?
    • About the same as a glove
    • burn
  11. A glove burn?
    • Immersion-Its an even
    • pattern at the bottom, some splashing at the top
  12. abusers tend to target the
    area for abuse
    that’s the cause of the problem
  13. most commonly identified explanation (trigger mechanism) for burn injuries due to abuse is
    toilet training
  14. Reference to Alfred Hitchcock movie—significance of the movie scene
    • Killing Someone Is Not Easy
    • Tom Curtain, 1966-Kills a man in a hotel roomtook about 5 mins
  15. Reference to police
    training—being shot
    early training they were told to shot twice but now they are taught to empty the gun

    • ○ Societal expectations when someone is shot
    • ○ Societal expectations when someone else is shot
  16. Reference to Sherwin Nuland’s book How We Die.
    the physiological processes of dying from a number of diseases,accidents, homicides, and etc
  17. Drowning is a form of

    ○ The mouth and nostrils are occluded by water
  18. Step 1 in drowning
    • The mouth and nostrils are occluded by water
  19. Suicide By Drowning
    Generally will not resist the inhalation of water
  20. Step 2--If
    accidental—or someone intentionally tries to drown someone—the victim will..
    • victim will fight by holding his breath until becoming too exhausted
    • and hypercarbic to continue. Hypercarbic-depletion of oxygen in the
    • blood
  21. Step 3 in drowning
    • Obstruction
    • ○ The air passages then become obstructed—all the way down to the lungs
    • ○ Note: near the surface there is the possibility of foaming from the mouth and a vomiting reflex
  22. Key
    question—the aspiration of water is delayed at first—WHY?
    Itis one of the body’s natural reflex mechanisms.
  23. how long does this last ( how long it take to drown?)
    About 2-3 minutes. When the water first hits the airways-the larynx reflexively goes into spasm and closes off in an effort to present further intake
  24. Step 4—what
    happens that causes it to relax?
    Decreasing oxygen in the blood and causes the larynx to relax
  25. Step 5—then what
    The water rushes into the lungs and fills them after about 5 mins
  26. Is the person dead if they have been drowning ?
    It depends, but you can always try to save them
  27. What
    happens in fresh water drowning?
    • The water is absorbed into the circulation through the lungs, the blood is diluted; the chemical imbalance is upset resulting in disequilibrium in the blood; red blood cells are destroyed; large amounts of potassium
    • are released into the circulation system and a cardiac poison that causes the heart to fibillate
  28. WHAT
    • The process is reversed—
    • water leaves the circulation and enters the aviola of the lungs
    • The same process as dying from pneumonia
  29. What form of drowning would you expect
    to find in a swimming pool?
    Salt water drowning b/c of the chlorine
  30. Does
    body mass play a role in drowning?
    • Yes, adipose tissue releases fat- fat is bouyant
    • ○ Think of children—especially babies—and fatty tissue ratio
    • ○ 10% of Caucasians and Hispanics are natural “sinkers”
    • ○ 90% of Blacks are natural “sinkers”
  31. Think of the movies—how do they portray a drowning victim once the body begins to sink?
    Is the body “dead”?
    On their side, feet first

  32. What is the significance of this knowledge for investigation of a drowning?

    Are there exceptions?
    For example, injuries to the head (cuts, abrasions, etc. may appear to have been inflicted prior to the drowning

    • Yes, about 15% of drowning victims are the result of “dry drowning”
    • ○ There may be no water in the lungs
    • ○ And, of course, the position of drowning victims may vary depending on circumstances
  33. How does the corpse of a drowning victim sink? In what position would you expect to find the body of a drowning victim?

    Are there exceptions?
    Head first. The head will looked scratched/cut and beat

    Yes, about 15 % of drowning victims are the result of “dry drowning”
  34. Shaken Baby Syndrome
    is a type of inflicted traumatic brain injury that happens when a baby is violently shaken. (National Institute of Neurological Disorders and Stroke
  35. What is the primary
    trigger mechanism for Shaken Baby Syndrome?
  36. Focal is..
    when a spot hits something in contact but diffuse is through the brain
  37. (Earthquake vs. Peak
    • Earthquake-slow moving back and forth.
    • Peak is rapid movement with abrupt stop
  38. Shaken baby is the result
    of a
    Repeated peak acceleration action
  39. Seven physiological
    aspects of shaken baby syndrome
    • (1) Bridging veins
    • (2) Subdural hematoma and bilateral subdural hemotama
    • (3) Concussions
    • (4) Shearing of brain tissue
    • (5) The eye
    • Detached retina
    • Retinal hemorrhaging
    • (6) Fracture Rib head, first rib, clavicle, and other bones
    • (7) Diffuse axonal injury
  40. The coverings of the brain-in order from top to bottom
    • a. skin-hair on top
    • b. skull-blood vessels on top
    • c. Dura Mater-subdural hematomas are right below this
    • d. Arachnoid
    • e. Pia Mater
    • f. the brain
  41. What is a concussion?
    Bruising of the brain tissue
  42. a concussion reduces
    normal flow of oxygen to the part of the brain
  43. Normally, a single concussion...
    doesn’t deplete all of the oxygen flow and, in time, the flow of oxygen returns to normal with no serious damage
  44. Repeated concussions in Short intervals result in
    additional oxygen deletion with successive concussions resulting in depletion of oxygen (ischemia) to the point that the brain matter cannot recover and necrosis (death) occurs.
  45. Shearing of arteries
    Most likely to result form Peak acceleration-deceleration forces

    when the brain is moving within the skull cavity
  46. Peak acceleration- deceleration causes what happens to the arteries (and nerves) in the brain?
    Bending and stretching the brain also slams against the wall of the skull
  47. Results of Peak acceleration-deceleration
    contusions/concussions but can also result in tearing of arteries
  48. Focal Injuries and
    possible results
    a direct blow to the head can also result in rupturing and shearing of the arteries within the brain and the veins in the dura cavity
  49. Clavicle
    the rib that’s going to break first is going to be in the front
  50. Brain atrophy
    • 3 stages
    • ????
  51. Pedophilia
    • is a medical term-- “The act or fantasy or engaging in sexual activity with pre-pubertal children as a repeatedly
    • preferred or exclusive method of achieving sexual excitement.”
  52. Hebephile
    The same definition as pedophilia, except the child has reached puberty.
  53. Child Molester
    “A significantly older individual who engages in any type of sexual activity with individuals legally defined as children"
  54. Munchausen Syndrome By Proxy defined
    A form of child abuse in which a parent or guardian fabricates or induces illness in a child.
  55. Who is the most common perpetrator?

    the mother
  56. Why is Munchausen Syndrome
    By Proxy so difficult to diagnose?
    The caretakers of the children are adept at deceiving medical and mental health professionals
  57. Most common form of MSBP
  58. Some reasons (5) that make MSBP difficult to prove
    • 1. The evidence is usually circumstantial.
    • 2. Physicians are not trained to identify.
    • 3. Physicians are uncomfortable with the concept of MSBP.
    • 4.Judges are reluctant to believe that the condition exists.
    • 5. Juries do not want to believe that mothers
    • would do such a thing
  59. Five General Facts to Consider with MSBP
    • 1. Perpetrators who engage in MSBP are often connected, or have been connected to, the medical profession or child care agencies
    • 2. The perpetrators research medical symptoms and conditions. They know what they are talking about
    • 3. Shopping--perpetrators move around from doctor to doctor, hospital to hospital.
    • 4. The children are often coached and become very good at faking and are convincing
    • 5. Mortality rates are estimated at about 10 %.
  60. what 2 types of monitoring did the hospital study from the MSBP lecture use
    video and voice
  61. Research Procedures of hospital study on MSBP
    • 1.Multidisciplinary team worked together at a hospital
    • 2. Emphasis on protecting the child
    • 3. When a child was admitted the family member signed a form. Included was permission to use video and sound monitoring
    • 4. Security officers monitored the surveillance cameras 24 hours a day.
    • 5. If something observed, the floor nurse was notified and immediately went to the room and intervened.
    • 6. Most of the cases were referred to this hospital because of the video surveillance and because a physician suspected MSBP.
    • 7. A team at the hospital decided that there was a high probability this was a case of MSBP before monitoring.
  62. were the family member in the hospital room (in the MSBP study ) monitored
  63. Two types of perpetrators of MSBP
    • 1. Inducers induce the disease or medical condition
    • directly.{(Note example given: smothering 1injection of bodily fluid (urine)}

    2. Fabricators No inducement of disease or medical condition.--Either creates symptoms by lying or stages the disease. (Note example given: mother vomits and then presents the vomit as coming from the child)
  64. chief medical complaints if children admitted to the hospital...
    • 1.Apnea/cyanosis
    • 2.Undiagnosed persistent symptoms
    • 3.Vomiting
    • 4.Sepsis
    • 5. Behavior problems
    • 6. Other
  65. Coaching MSBP
    Some of the mothers were overheard coaching their child to display the symptoms.
  66. 41 cases were monitored at the hospital how many were confirmed as MSBP? and what types?
    • 23 confirmed
    • 10 fabricators
    • 2 inducers
    • 11 both
    • § 2 of these confirmed by lab drug tests
    • § 2 by direct observation
    • § 1 confessed when questioned

    • ○23 cases confirmed
    • ○13 required video monitoring to prove
    • ○5 the video monitoring was supportive
    • ○5 video monitoring was not necessary
  67. All of the perpetrators of the confirmed cases of MSBP
    were what type of caregiver to the child?
    the mother of the child
  68. Monitoring resulted in how many of the 41 suspected perpetrators being proved innocent?
  69. What across the counter medicine is frequently used to induce vomiting by MSBP perpetrators?
  70. Many perpetrators use MSBP as a way of
    gaining social attention and social acceptance
  71. Can fabricating a child’s illness ever be considered a crime?
  72. What singer produced a well known song about his own experience with MSBP?
  73. What is the current medical theory as to why repeated concussions to the same place on the brain, in short
    successive periods, results in permanent loss of the brain matter?
    • A concussion reduces the normal flow of oxygen to that part of the brain. Normally, a single concussion does not deplete all of the oxygen flow and, in time, the flow of oxygen returns to normal with no serious
    • damage. Repeated concussions in short intervals results in additional oxygen depletion with eachsuccessive concussion resulting in depletion of oxygen (ischemia) to the point that the brain matter
    • cannot recover and necrosis occurs.
  74. What is the physiological mechanism by
    which the concussed area is deprived of oxygen.
    • During a concussion, arteries constrict, slowing blood flow to the brain. At the same time, calcium floods the energy-producing portions of brain cells. That calcium
    • plays a mean defense, blocking oxygen- and glucose-rich blood from replenishing neurons' energy supply.
  75. If the area of the brain what has suffered a concussion is not allowed sufficient time to heal, what happens when there is a second concussion to the same area?
    • The constriction of arteries increases and additional calcium floods the energy-producing portions of brain
    • cells. The flow of oxygen is further depleted and may be reduced completely or sufficiently to the point that cells in this part of the brain die. Remember, necrotic brain cells are not replaced by new brain cells.
  76. Why is playing sports with concussion symptoms so risky?
    During a concussion, arteries constrict, slowing blood flow to the brain. At the same time, calcium floods the energy-producing portions of brain cells. That calcium plays a mean defense, blocking oxygen- and glucose-rich blood from replenishing neurons' energy supply. Brain cells get sluggish, and a concussed athlete who can't focus or suffers from slower reaction times is left more susceptible to a slew of other injuries, including another concussion. A second blow to the head could lead to more arterial constriction and more calcium infusions.
  77. In Loco Parentis means--
    in place of the parents
  78. a person commits the offense of "Injury to a child" if...
    they intentionally…causes serious bodily injury
  79. Indecency with a child

    (penal code 21.11)
    • With the intent is to arouse or gratify the sexual desire of any person
    • Affirmative defense:
    • -Opposite sex, didn’t use duress, force, or threat, was more that 3 yrs older than the victim
    • -The child can not give consent
  80. can you be charged for with sexual assault of your spouse?
  81. what does the prodecutor have to provide to charge someone with Indecency with a Child?
    must provide the burden of proof that the child is 17 or younger
  82. Accepting Possession of Certain Abandoned Children
    -- Baby Moses Law
    • A designated emergency infant care provider shall, with ought a court order, take possession of a child who appears to be 60 days or younger if the child is voluntarily delivered to the provider by the child’s parent and the parent didn’t express an intent to return
    • for the child
  83. what infomation should you always keep if reporting child abuse
    the report number and/or the police officers name and contact information
  84. if you discover/suspect a child is being abused when must you report it?
  85. who is legally required to report child abuse?
    Anyone age 18 or older and it must be reported if you know about it
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