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Is trauma self-inflicted? You can do these 3 things
Don't be judgmental, ED nurse advises
(Editor's note: This is the third of a three-part series on trauma care in the ED. This story covers self-inflicted trauma. Previous issues covered neurological assessment of children involved in motor vehicle accidents and violence-related trauma.)
ED nurses are seeing increasing numbers of self-inflicted trauma cases, particularly in female patients.
"In the past few weeks, I know of at least three women admitted with intentionally self-inflicted stab wounds," says Regina Curry, RN, an ED nurse at Thomas Jefferson University Hospital in Philadelphia.
Curry adds that in her experience, male patients are more likely to use violent means, such as firearms or knives to self-injure, while women tend to use more passive means such as drug overdoses. To improve care, do these three things:
• Look for signs that patients' injuries were self-inflicted, even if their histories says otherwise.
"Teenage girls may try to conceal cuts on their arms, legs, abdomen, and inner thighs by wearing long sleeves and pants on hot days," says Curry. "Self-inflicted wounds look deliberate. Scabs in neat rows are typical. You can also see signs of compulsive acts like skin picking or hair pulling."
• Offer help in a nonjudgmental way.
"These patients want their feelings to be taken seriously. They need help and guidance," Curry says.
• Arrange follow-up for problems you can't solve.
Helping your patient get the proper follow-up care could be the most important intervention you can do. "I saw a camp nurse bring a girl to the ED for 'pink-eye.' It turns out she was pulling out her own eyelashes. She had problems that could not be fixed in an ED, obviously," says Curry. "Utilizing social work for home follow-up was helpful and gave me some peace of mind."