Traumatic brain injury (TBI) causes two injury types: primary and secondary. In infants and young children, nonaccidental TBI is an important etiology of brain injury and is commonly a repetitive insult. TBI is by far the most common cause of acquired brain injury (ABI) in children and is the most common cause of death in cases of childhood injury. In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) issued validated prediction rules to identify children at very low risk of clinically important TBI, which is defined as TBI requiring neurosurgical intervention or leading to death. The range of outcomes in pediatric TBI is very broad, from full recovery to severe physical and/or intellectual disabilities. Children and adolescents who have suffered a TBI are at increased risk of social dysfunction. Studies show that these patients can have poor self-esteem, loneliness, maladjustment, reduced emotional control, and aggressive or antisocial behavior.
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In the postpartum period, secondary postpartum hemorrhage (SPPH) and endometritis are two conditions that frequently present to an obstetric triage unit. These complications may coexist and can occur from 24 hours postpartum to 6 weeks postdelivery. SPPH is typically not as severe as a primary bleeding episode. Postpartum women ultimately diagnosed with endometritis are generally stable, but less commonly can present in septic shock. This chapter discusses presenting symptomatology, history and data collection, physical examination, laboratory and imaging studies, differential diagnosis, and clinical management and follow-up of secondary postpartum hemorrhage and postpartum endometritis. Prompt treatment of both SPPH and postpartum endometritis can reduce maternal morbidity and mortality. SPPH is managed with the same guiding principles as primary postpartum hemorrhage. Initial treatment for postpartum endometritis is intravenous clindamycin and gentamicin.
Pregnant women presenting with abdominal pain to an emergency department or obstetric triage setting frequently have a diagnostic ultrasound (US) to assess fetus, placenta, and adnexae. In the first trimester, symptomatic adnexal masses typically present with unilateral or bilateral pelvic cramping or pressure. Obtaining a history in a pregnant woman with abdominal pain is similar to doing so for the nonpregnant patient. In addition to routine cardiopulmonary examination, abdominal examination, and assessment for costovertebral angle tenderness, a sterile speculum and vaginal examination are performed to evaluate for adnexal or uterine tenderness, cervical dilation, and potential rupture of membranes. If a mass is suspected, US is the preferred imaging modality. Magnetic resonance imaging can be employed if additional imaging is needed. Differential diagnosis of abdominal pain in pregnant women must include other obstetric and nonobstetric causes of pain. This chapter describes clinical management and follow-up of pregnant women with adnexal masses.
Maternal sepsis is a common pregnancy-related condition; in the United States, it is a leading cause of maternal mortality, accounting for up to 28” of maternal deaths and up to 15” of maternal admissions to the intensive care unit. One contributing and modifiable factor to these deaths is failure to recognize sepsis, leading to delays in treatment. Therefore, rapid and accurate diagnosis and initial management of sepsis in pregnancy in the emergency department (ED) is paramount. Pregnancy poses a unique challenge given the baseline physiologic changes and the need to care for the mother while simultaneously caring for the fetus. Therefore, without clear pregnancy-specific data, recommendations are to follow the current guidelines for nonpregnant adults, yet be cognizant of the ways in which pregnancy may change maternal physiology and affect fetal well-being. Prompt identification and treatment of maternal sepsis will undoubtedly lead to the best possible maternal and neonatal outcomes.
Intimate partner violence (IPV) and sexual assault are common violent crimes perpetrated on women. Obstetric (OB) complications associated with trauma include miscarriage, preterm labor, and placental abruption. Ongoing mental health issues, including depression and anxiety, are more prevalent in pregnant women subjected to any form of IPV, whether or not direct physical violence is involved. One study showed that pregnant women subjected to verbal threats were twice as likely to deliver low-birth-weight infants. All women who present to an OB triage unit or an emergency department (not just those who present with an injury or complication) must be screened for IPV. An organized plan for providing the victim with resources must be readily available when a screen is positive. This chapter discusses presenting symptomatology, history and data collection, physical examination, laboratory and imaging studies, differential diagnosis, clinical management and follow-up care of IPV and sexual assault.
- Go to chapter: Neurodevelopmental Disabilities: Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder
Neurodevelopmental Disabilities: Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder
This chapter defines neurodevelopmental disorders, and examines the medical, psychosocial, and vocational aspects of two neurodevelopmental disorders that are increasing in the U.S. population: autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). It provides populations at risk of being diagnosed with ASD or ADHD, and distinguishes key considerations for outreach, eligibility determination, and rehabilitation assessment and planning. The chapter considers services to be included in the rehabilitation plan to facilitate goal achievement for consumers with ASD or ADHD, and examines evidence-based practices in job development, placement, and retention. Both ASD and ADHD can be accompanied by co-occurring psychiatric disabilities. Counseling and guidance are always individualized to the unique characteristics, rehabilitation needs, and preferences of each rehabilitation consumer. Rehabilitation counselors must also take into consideration the importance of family involvement in the transition and rehabilitation of youths with ASD and ADHD.
This chapter describes changes in the age demographic of the American populace that will steadily increase the number of elderly people in the United States for the next 30 years, and examines the relationship among aging, health, and disability. It provides the characteristics and needs of people who have frequently occurring aging-related disabling conditions such as dementia, rheumatoid arthritis, and stroke. The most common chronic health conditions for people over the age of 65 include arthritis, hypertensive disease, heart disease, hearing impairments, musculoskeletal impairments, chronic sinusitis, diabetes, and visual impairments. It is important for rehabilitation counselors to understand the impact that population aging has had and will continue to have on family interaction and socialization, the American economy, and human health care and social service systems. In providing counseling and guidance services to individuals with age-related disabilities, the issue of chronicity is often of paramount concern.
This chapter examines the roles that lifestyle factors and climate change play in the onset and exacerbation of emerging disabilities, and provides examples of chronic illnesses and disabilities linked to lifestyle and climate change that are increasing in the population. It considers the medical, psychosocial, and vocational characteristics of emerging disabilities associated with lifestyle and climate change, and explores characteristics of populations at risk of acquiring disabilities and chronic illnesses associated with lifestyle and climate change. The respective incidences of diabetes, asthma, and heart disease have reached epidemic proportions in the United States. The chapter presents an overview of the health impacts of extreme heat, extreme weather events, air pollution, and vector-borne diseases. Temperature increases, changing precipitation patterns, and extreme weather events have resulted in the increased spread of vector-borne diseases. Health promotions services may be especially beneficial to individuals with lifestyle disabilities to assist them with changing health-related behaviors.
This chapter examines the medical, psychosocial, and vocational characteristics, challenges, and rehabilitation needs of emerging populations of individuals with psychiatric disabilities, and introduces a recovery-oriented approach to providing responsive services to individuals with psychiatric disabilities. It explores integrated, evidence-based, and emerging practices to facilitate better recovery and rehabilitation outcomes for these populations. The onset of psychiatric disabilities occurs during critical years when major changes are occurring in the areas of identity formation and cognitive, psychosocial, psychosexual, and career development. Many individuals with psychiatric disabilities receive their health care in emergency departments and intensive care units and not until their secondary conditions create medical crises. Substance use disorders (SUDs) often co-occur with psychiatric disabilities. The principles of recovery align with the core values and principles of rehabilitation counseling. Illness management and recovery (IMR) is an evidence-based practice for equipping individuals with the knowledge and skills they need to self-manage their disabilities.
This chapter defines emerging disabilities; explores medical, psychosocial, and vocational implications of emerging disabilities that distinguish them from traditional disabilities; and provides demographic characteristics of individuals who are most vulnerable to acquiring emerging disabilities. It examines some social and environmental trends that have contributed to the development of emerging patterns and types of disabilities including advances in medicine and assistive technology, globalization, climate change, poverty, violence and trauma, the aging American populace, and disability legislation. Psychological and physical trauma from warfare, violent crime, intimate partner violence, and youth violence can result in permanent physical, cognitive, and psychiatric disabilities. Diagnostic uncertainties, misdiagnoses, and skepticism on the part of medical providers are frequently associated with emerging disabilities. Women also represent a population that is at an increased risk of acquiring emerging disabilities and chronic illnesses. Rehabilitation systems are still not fully prepared to address the multifaceted needs of individuals with emerging disabilities.