Research issues in domestic violence woman in the emergency department

394 netics have not yet been clarified. A child’s risk of developing Asthma is approximately 20% if one parent is affected and 63.6% if both parents are affected. Death rates from Asthma have increased 3 1% since 1980. Review of Asthma deaths has identified inadequate therapy and lack of emergency management plans as the main causes. This talk will review: the pathophysiology of Status Asthmaticus; aggressive inhalation therapy; early administration of steroids; and an approach to the child who needs ventilation. [Anna Jarvis, MD]

Cl ABDOMINAL PAIN MANAGEMENT IN THE EMERGENCY DEPARTMENT Abdominal pain is a frequent complaint in the Emergency Department. In one study, more than 40% of emergency visits were attributable to the diagnosis of “undifferentiated abdominal pain.” The classic dilemma the emergency physician faces in treating these patients is: should analgesics be given to relieve discomfort, or could the medication obscure the ability to accurately diagnose the etiology? We will examine the literature to determine how the administration of analgesics can affect the clinician’s ability to diagnose abdominal pain. We will also discuss further areas of research needed to establish the safety of analgesic use in abdominal pain. [Kendall Ho, MD]

0 IDENTIFICATION AND CARE OF THE ABUSED WOMAN IN THE EMERGENCY DEPARTMENT In recent years physicians and nurses in Canada and the United States have been repeatedly urged by professional organizations and others in their communities to recognize domestic violence against women as a health issue of great importance. As yet, however, the scope and impact of domestic assault has not prompted wide-scale development of hospital-based education and treatment interventions. We review findings from the first three years of operation of one such program in Canada: the Domestic Violence Program at Vancouver Hospital and Health Sciences Center in Vancouver, British Columbia. The program has established a method for identifying and treating women who have been battered and has assembleda computerized databaseto provide aggregate information concerning various patient characteristics. We propose practical Guidelines of Care for emergency physicians and nurses. [Anton Grunfeld, MD, Deborah Hatch, PIID, and Kathleen Mackay, MSW]

0 RESEARCH ISSUES IN DOMESTIC VIOLENCE As an example of a “sensitive topic of research,” studying domestic violence often involves situations and issues that are not factors when conducting research in other areas. Several of these concerns will be described, including: access to abused individuals as research participants; possibly compromised data quality; participant and researcher safety; and, interviewer effects. Two types of research will be con-

CAEP ‘96 Abstracts sidered: ( 1) studies that focus on the individual who has experienced abuse; and (2) evaluation research designed to assessthe implementation and outcome of domestic violence intervention programs. Particular attention will be given to addressing domestic violence research in the context of hospital emergency departments and how research concerning domestic violence bears on clinical work in emergency departments. [Deborah Hatch, PIID, Anton Grunfeld, MD, and Kathleen Mackay, MSW]

Cl WELLNESS ISSUES IN EMERGENCY MEDICINE: SHIFTWORK AND BURNOUT IN THE EMERGENCY DEPARTMENT Does shiftwork physically lead to being unwell? Can all people adapt to shiftwork? Does shiftwork indirectly lead to disaffection, by decreasing time with family or friends? How can shiftwork best be planned to avoid physical and mental duress? Why do emergency groups ignore this latter issue? These issues will be reviewed and discussed, with the aim of arriving at directed suggestions to improve wellness in this area in your department. [James Ducharme, MD]

Cl MANAGEMENT OF MIGRAINE HEADACHES: IS THE HEADACHE GONE ONCE THE PATIENT HAS LEFT? Emergency policy for many conditions is to ensure patient care not only in the emergency department, but after discharge as well. This is not the case in migraine management. Historically, these patients received an IM opioid and were sent home. Today, although therapy is more directed with 5-HT specific medications, little if any attention is turned toward what happens to the patient once he or she leaves our care. Data from sumatriptan studies suggest that up to 50% have headacherecurrence the following day. This presentation will review the literature on the recurrence rate of headacheswith common medications as well as significant side effects that prevent return to normal function. New data on what happens after discharge will also be presented. [James Ducharme, MD]

0 COMMUNICABLE DISEASES IN THE EMERGENCY DEPARTMENT This talk will focus on communicable diseases in the emergency department. These will include diseasesthat can be transmitted by the airborne route, most notably tuberculosis, agents of meningitis, pertussis, and to a lesser extent, chicken pox and measles.The emphasis will be on recognizing the risks and preventative measures. This will be followed by a discussion on exposure to blood borne pathogens with an emphasis on risk of transmission and management of needlestick and mucocutaneous blood exposures. In addition, a potpourri of infectious agents will be described that pose a threat of communicability both to the casualty officers and other patients in the emergency department. Agents of gastroenteritis, hemorrhagic conjunctivitis, as well as exotic