sexta-feira, 11 de novembro de 2016

Enfermagem Forense que se passa?

Lamento profundamente as palavras que vou escrever mas tem que ser. A enfermagem forense não pode, nem deve ser usada da forma que é usada por várias pessoas em alguns países. Usam a enfermagem forense para ter fama, poder e protagonismo. Pessoas como estas não dignificam a profissão. Assiste-se hoje a uma guerra absurda de poder, tentam desafiar-se para ver quem manda mais e quem tem mais poder. Mas no fundo para quê?? Algumas mentes perturbadas que andam a manipular pessoas com pouca inteligência e lucidez, nem sequer tem coragem para assumir que não exercem enfermagem forense, e depois vendem ilusões, quando são elas próprias que fazem as falsas propostas de eventual reconhecimento que simplesmente não existem. Coitadas, é apenas o que posso dizer, e posso dizer que o seu comportamento não passa despercebido por ninguém e muito menos pelas verdadeiras instituições que representa a enfermagem forense. Acabe-se com esta fantochada porque devemos trabalhar para cuidar de quem sofre e não para pseudo títulos apenas para fama e poder. 

segunda-feira, 3 de outubro de 2016


Approach To Interpretation Of Medical Findings In Suspected Child Sexual Abuse

This table lists medical and laboratory findings; however, most children who are evaluated for suspected sexual abuse will not have signs of injury or infection. The child’s description of what happened to him or her and the child’s report of specific symptoms in relationship to the events described is an essential part of the full medical evaluation.
Findings Documented in Newborns or Commonly Seen in Nonabused Children
(The presence of these findings generally neither confirms nor discounts a child’s clear disclosure of sexual abuse.)
1. Periurethral or vestibular bands
2. Intravaginal ridges or columns
3. Hymenal bumps or mounds
4. Hymenal tags or septal remnants
5. Linea vestibularis (midline avascular area)
6. Hymenal notch/cleft in the anterior (superior) half of the hymenal rim (prepubertal girls), on or above the 3 o’clock–9 o’clock line with patient supine
7. Shallow/superficial notch or cleft in inferior rim of hymen below 3 o’clock–9 o’clock line
8. External hymenal ridge
9. Congenital variants in appearance of hymen, including crescentic, annular, redundant, septate cribiform, microperforate, and imperforate
10. Diastasis ani (smooth area)
11. Perianal skin tag
12. Hyperpigmentation of the skin of labia minora or perianal tissues in children of color, such as Mexican-American and African-American children
13. Dilation of the urethral opening with application of labial traction
14. “Thickened hymen” (May be due to estrogen effect, folded edge of hymen, swelling from infection, or swelling from trauma. The latter is difficult to assess unless follow-up examination is done.)
Findings Commonly Caused by Other Medical Conditions
15. Erythema (redness) of the genital tissues (May be due to irritants, infection, or dermatitis.)
16. Increased vascularity (“dilatation of existing blood vessels”) of vestibule and hymen (May be due to local irritants or normal pattern in the nonestrogenized state.)
17. Labial adhesion (May be due to irritation or rubbing.)
18. Vaginal discharge (There are many infectious and noninfectious causes. Cultures must be taken to confirm if caused by sexually transmitted organisms or other infections.)
19. Friability of the posterior fourchette or commisure (May be due to irritation, infection, or an examiner’s traction on the labia majora.)
20. Anal fissures (Usually due to constipation, perianal irritation.)
21. Venous congestion or venous pooling in the perianal area (Usually due to positioning of child. Also seen with constipation.)
Conditions Mistaken for Abuse
22. Urethral prolapse
23. Lichen sclerosus et atrophicus
24. Vulvar ulcers (May be caused by many types of viral infections, including Epstein-Barr virus [EBV] and influenza, or by conditions such as Behcet’s disease or Crohn’s disease.)
25. Failure of midline fusion, also called perineal groove
26. Rectal prolapse (Often caused by infection, such as Shigella sp.)
27. Complete dilation of the internal and external anal sphincters, less than 2 centimeters in AP diameter, revealing the pectinate line
28. Partial dilation of the external anal sphincter, with the internal sphincter closed, causing the appearance of deep folds in the perianal skin that can be mistaken for signs of injury
29. Marked erythema, inflammation, and fissuring of the perianal or vulvar tissues due to infection with Group A beta hemolytic streptococci
(These physical and laboratory findings may support a child’s clear disclosure of sexual abuse, if one is given, but should be interpreted with caution if the child gives no disclosure. Report to child protective services may be indicated in some cases.)
30. Deep notches or clefts in the posterior/inferior rim of hymen that extend through more than 50% of the width of the hymen
31. Deep notches or complete clefts in the hymen at the 3 o’clock or 9 o’clock location in adolescent girls
32. Marked, immediate anal dilation to an AP diameter of 2 cm or more, in the absence of other predisposing factors such as chronic constipation, sedation, anesthesia, and neuromuscular conditions

33. Genital or anal condyloma accuminata in child, in the absence of other indicators of abuse. Lesions appearing for the first time in a child older than 5–8 years may be more suspicious for sexual transmission.
34. Herpes Type 1 or 2 in the genital or anal area in a child with no other indicators of sexual abuse. Isolated genital lesions caused by HSV-2 in a child older than 4–5 years may be more suspicious for sexual transmission.
Findings Diagnostic of Trauma and/or Sexual Contact
(The following findings support a disclosure of sexual abuse, if one is given, and are highly suggestive of abuse even in the absence of a disclosure, unless a clear, timely, plausible description of accidental injury is provided by the child and/or caretaker. Photographs or video recordings of these findings should be reviewed by an expert in sexual abuse evaluation for a
second opinion to assure accurate diagnosis.)
35. Acute lacerations or extensive bruising of labia, penis, scrotum, perianal tissues, or perineum (May be from unwitnessed accidental trauma or from physical or sexual abuse.)
36. Fresh laceration of the posterior fourchette, not involving the hymen (Must be differentiated from dehisced labial adhesion or failure of midline fusion; see #25. Posterior fourchette lacerations may also be caused by accidental injury or by consensual sexual intercourse in adolescents.)
(These rare findings are difficult to assess unless an acute injury was previously documented at the same location.)
37. Perianal scar (May be due to other medical conditions such as Crohn’s disease, accidental injuries, or previous medical procedures.)
38. Scar of posterior fourchette or fossa (Pale areas in the midline may also be due to linea vestibularis or labial adhesions.)
39. Extensive bruising on the hymen
40. Laceration (tear, partial or complete) of the hymen (acute)
41. Perianal lacerations extending deep to the external anal sphincter (Not to be confused with partial failure of midline fusion.)
42. Hymenal transection (healed): An area between 4 o’clock and 8 o’clock on the rim of the hymen, where it appears to have been torn through, to or nearly to the base, so there appears to be virtually no hymenal tissue remaining at that location. This finding has also been referred to as a “complete cleft” in sexually active adolescents and young adult women.
43. Missing segment of hymenal tissue. Area in the posterior (inferior) half of the hymen, wider than a transection, with an absence of hymenal tissue extending to the base of the hymen, which is confirmed using additional positions or methods.
44. Positive confirmed culture for gonorrhea, from genital area, anus, or throat, in a child outside the neonatal period
45. Confirmed diagnosis of syphilis, if perinatal transmission is ruled out
46. Trichomonas vaginalis infection in a child older than 1 year of age, with organisms identified by culture or, in vaginal secretions, by wet mount examination
47. Positive culture from genital or anal tissues for chlamydia, if child is older than 3 years at time of diagnosis and if specimen was tested using cell culture or comparable method approved by the Centers for Disease
48. Positive serology for HIV if perinatal transmission, transmission from blood products, and needle contamination have been ruled out
49. Pregnancy
50. Sperm identified in specimens taken directly from a child’s body