Assault and Interpersonal Violence EvaluationAPPROACH

TRAUMA AND WOUNDS · 16 SECTIONS

⚲

562 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

Motor Vehicle Collision Evaluation Chest Wall Trauma And Rib Injury Blunt Abdominal Trauma Evaluation Penetrating Trauma Evaluation Pediatric Minor Head Trauma Pediatric Head Trauma Facial Lacerations And Dental Trauma Hand Lacerations With Tendon Injury Concern Puncture Wounds And Retained Foreign Body Concern Electrical Injury Burn Injury Fall Evaluation Assault And Interpersonal Violence Evaluation Eye Trauma And Hyphema Concern

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx84

Event details

›Event details

›Time since event

›Location and setting

›Number of assailants

›Known or unknown assailant

›Type of force

›Blunt

›Sharp

›Burn

›Bite

›Chemical exposure

›Weapons involved

›Firearm exposure

›Knife or sharp object

›Other weapon

›Ground level fall after assault

›Loss of consciousness

›Amnesia or confusion

›Substance use around event

›Alcohol

›Stimulants

›Opioids

›Sedatives

Strangulation specific history

›Strangulation specific history

›Manual neck compression

›Ligature neck compression

›Duration estimate

›Voice change

›Breathing difficulty during event

›Swallowing pain or difficulty

›Neck pain

›Neurologic symptoms

›Weakness

›Numbness

›Vision change

›Headache

›Incontinence during event

›Pregnancy status if relevant

Sexual violence exposure history

›Sexual violence exposure history

›Type of contact

›Oral

›Vaginal

›Anal

›Condom or barrier use

›Time since assault for prophylaxis windows

›Post assault bathing or clothing change

›Current genitourinary symptoms

›Bleeding

›Pain

›Dysuria

›Pregnancy risk

›STI risk concerns

Pain or focal symptom OPQRST

›Pain or focal symptom OPQRST

›Onset

›Sudden

›Gradual

›Provocation or palliation

›Worse with movement

›Worse with breathing

›Relief with rest

›Quality

›Sharp

›Dull

›Burning

›Region or radiation

›Primary location

›Radiation pattern

›Severity

›Current severity

›Peak severity

›Timing

›Constant

›Intermittent

Safety and social context

›Safety and social context

›Current safety

›Safe place to return

›Assailant access to patient

›Children or dependents at risk

›Elder or vulnerable adult concerns

›Police involvement preference

›Forensic evidence collection preference

›Past episodes of violence

›Threats to life

›Stalking or coercive control indicators

02Alarm Features/alarm47

Immediate life threats

›Immediate life threats

›Airway compromise

›Stridor

›Drooling

›Rapidly progressive neck swelling

›Respiratory compromise

›SpO2 less than 92 percent on room air

›Severe dyspnea

›Hemorrhagic shock

›Systolic BP less than 90 mmHg

›Altered mental status with hypotension

›Major hemorrhage

›Uncontrolled external bleeding

›Suspected internal bleeding

Neuro red flags

›Neuro red flags

›GCS less than 13

›Focal neurologic deficit

›Repeated vomiting

›Seizure

›Severe or worsening headache

›New confusion or agitation

Strangulation red flags

›Strangulation red flags

›Voice change

›Neck bruising or ligature marks

›Dysphagia or odynophagia

›Dyspnea

›Syncope or near syncope

›Petechiae of face or conjunctiva

›Focal neurologic symptoms

›Significant neck tenderness over larynx

Abdominal and chest red flags

›Abdominal and chest red flags

›Chest pain with trauma

›Absent breath sounds

›Crepitus

›Abdominal rigidity

›Rebound tenderness

›Seat belt pattern injury

›Hematemesis

Pregnancy and gynecologic red flags

›Pregnancy and gynecologic red flags

›Positive pregnancy test with abdominal pain

›Heavy vaginal bleeding

›Syncope with pelvic pain

›Concern for sexual assault with severe pain

Escalation triggers

›Escalation triggers

›If airway concern after strangulation, early anesthesia and ENT involvement

›If hemodynamic instability, trauma team activation per local protocol dependent

›If suicidal ideation, immediate mental health safety evaluation

03Medications/meds30

Current medications and interactions

›Current medications and interactions

›Anticoagulants

›Warfarin

›DOACs

›Antiplatelets

›Aspirin

›Clopidogrel

›Insulin and glucose lowering agents

›Antihypertensives

›Antiepileptics

›Psychiatric medications

›SSRIs

›Antipsychotics

›Chronic opioids

›Recent sedatives

›Benzodiazepines

›Z drugs

Analgesia and sedation considerations

›Analgesia and sedation considerations

›NSAID contraindications

›Kidney disease

›GI bleeding history

›Acetaminophen daily maximum

›Opioid risk factors

›Sleep apnea

›Concurrent sedatives

Sexual assault prophylaxis medication review

›Sexual assault prophylaxis medication review

›Hormonal contraception use

›Current pregnancy

›HIV PrEP use

›Hepatitis B immunization status

04Diet/diet8

Intake and fasting considerations

›Intake and fasting considerations

›Last oral intake time

›NPO considerations if procedural sedation anticipated

Substance and dehydration context

›Substance and dehydration context

›Alcohol intake recent

›Energy drinks or caffeine excess

›Poor intake due to stress or injury

›Vomiting or poor hydration

05Review of Systems/ros35

Neurologic and head

›Neurologic and head

›Headache

›Dizziness

›Vision change

›Weakness

›Numbness

›Memory gaps

Cardiopulmonary

›Cardiopulmonary

›Chest pain

›Shortness of breath

›Palpitations

›Cough

GI and abdominal

›GI and abdominal

›Abdominal pain

›Nausea

›Vomiting

›Blood in stool

GU and gynecologic

›GU and gynecologic

›Dysuria

›Hematuria

›Vaginal bleeding

›Pelvic pain

›Penile or testicular pain

Musculoskeletal and skin

›Musculoskeletal and skin

›Limb pain

›Joint swelling

›Back pain

›Wounds

›Burns

Psychological

›Psychological

›Acute anxiety

›Panic symptoms

›Sleep disturbance

›Hypervigilance

›Dissociation

06Collateral History and Family History/chafh14

Collateral sources and reliability

›Collateral sources and reliability

›EMS report

›Police report if available

›Family or friend account

›Shelter or community worker account

Family history

›Family history

›Bleeding disorders

›Early cardiovascular disease

›Seizure disorders

Social supports and dependents

›Social supports and dependents

›Safe contact person

›Dependent children safety

›Elder or vulnerable adult safety

›Housing stability

07Risk Factors/rf27

Medical risk modifiers

›Medical risk modifiers

›Anticoagulant use

›Bleeding disorder

›Pregnancy

›Older age

›Immunocompromise

Injury pattern risks

›Injury pattern risks

›Strangulation history

›Head strike

›High energy mechanism

›Penetrating injury

Violence recurrence and lethality risk

›Violence recurrence and lethality risk

›Escalating frequency or severity

›Threats with weapons

›Prior strangulation episodes

›Isolation from supports

›Assailant access to firearms

Sexual violence risk factors

›Sexual violence risk factors

›Unknown assailant

›Multiple assailants

›Mucosal exposure

›Delay to presentation affecting prophylaxis windows

Child and elder protection risk factors

›Child and elder protection risk factors

›Injuries inconsistent with history

›Delay in seeking care

›Poor supervision concerns

›Dependence on caregiver

08Differential Diagnosis/ddx67

Life threatening

›Life threatening

›Intracranial hemorrhage

›Anticoagulation increases risk

›Worsening headache or vomiting increases concern

›Cervical spine injury

›Midline neck tenderness increases concern

›Neurologic deficits increase concern

›Blunt cerebrovascular injury

›Strangulation with neuro symptoms increases concern

›Neck pain with focal deficits increases concern

›Laryngeal fracture or airway edema

›Stridor increases concern

›Voice change increases concern

›Pneumothorax or hemothorax

›Unilateral breath sound decrease increases concern

›Hypoxia increases concern

›Solid organ injury

›Abdominal tenderness increases concern

›Hypotension increases concern

›Compartment syndrome

›Pain out of proportion increases concern

›Pain with passive stretch increases concern

›Pregnancy related emergency

›Ectopic pregnancy (O00.9)

›Placental abruption (O45.9)

Common

›Common

›Concussion (S06.0X0A)

›Headache with normal imaging possible

›Symptoms can be delayed

›Contusion or hematoma (T14.8)

›Localized swelling and tenderness

›Anticoagulants increase expansion risk

›Laceration (S01 to S91)

›Infection risk by location

›Tendon or nerve injury as complication

›Fracture

›Point tenderness increases concern

›Deformity increases concern

›Sprain or strain

›Pain with range of motion

›Swelling without deformity

›Acute stress reaction (F43.0)

›Anxiety and insomnia

›Hyperarousal

Less common

›Less common

›Retinal injury

›Vision change

›Eye pain

›Rhabdomyolysis (M62.82)

›Prolonged immobilization

›Dark urine

›Toxic ingestion or intoxication

›Altered mental status

›Mixed substance exposure

›Occult vascular injury

›Expanding hematoma

›Distal ischemia

Mimics and pitfalls

›Mimics and pitfalls

›Medical syncope preceding injury

›Prodrome suggests syncope

›No clear assault mechanism

›Seizure preceding injury

›Tongue bite

›Postictal confusion

›Domestic violence underreporting

›Injuries in multiple healing stages

›Hesitant or inconsistent narrative

09Past Medical History/pmh18

Relevant conditions

›Relevant conditions

›Prior traumatic brain injury

›Prior strangulation episodes

›Seizure disorder (G40.909)

›Bleeding disorder (D68.9)

›Chronic kidney disease (N18.9)

›Diabetes mellitus (E11.9)

›Pregnancy history if relevant

Prior procedures and devices

›Prior procedures and devices

›Prior head or neck surgery

›Anticoagulation indication

›Implanted devices

›Pacemaker

›Vascular grafts

Baseline function and supports

›Baseline function and supports

›Baseline mobility

›Cognitive baseline

›Baseline mental health supports

10Physical Exam/exam69

Primary survey and vitals

›Primary survey and vitals

›Airway

›Voice quality

›Stridor

›Breathing

›Work of breathing

›Symmetry of chest rise

›Circulation

›Skin perfusion

›External bleeding

›Disability

›GCS

›Pupils

›Exposure

›Full skin survey with consent

›Temperature

Head and face

›Head and face

›Scalp hematoma

›Facial tenderness and deformity

›Oral trauma

›Dental injury

›Mucosal lacerations

›Eye exam when indicated

›Visual acuity

›Extraocular movements

Neck and strangulation findings

›Neck and strangulation findings

›Anterior neck tenderness

›Bruising or abrasions

›Ligature marks

›Tracheal deviation

›Laryngeal crepitus

›Carotid tenderness

›Cervical spine tenderness

Chest and cardiovascular

›Chest and cardiovascular

›Chest wall tenderness

›Rib crepitus

›Breath sounds

›Heart sounds

›Peripheral pulses symmetry

Abdomen and pelvis

›Abdomen and pelvis

›Tenderness by quadrant

›Guarding

›Distension

›Pelvic tenderness

›Flank ecchymosis

Extremities and neurovascular

›Extremities and neurovascular

›Deformity

›Range of motion limits

›Distal pulses

›Capillary refill

›Sensation

›Motor function

Neurologic

›Neurologic

›Cranial nerves screen

›Strength symmetry

›Sensory deficits

›Coordination

›Gait if safe

Skin and wound documentation

›Skin and wound documentation

›Injury mapping by location

›Size measurements

›Color and pattern description

›Photo documentation per policy and consent

›Forensic chain of custody considerations per local protocol dependent

Behavioral and mental status

›Behavioral and mental status

›Orientation

›Affect

›Intoxication signs

›Immediate safety concerns

11Lab Studies/labs35

Core trauma and bleeding risk labs

›Core trauma and bleeding risk labs

›CBC

›Anemia suggests bleeding

›Leukocytosis nonspecific

›Electrolytes and creatinine

›Kidney function for contrast decisions

›Baseline for medication dosing

›Coagulation studies when indicated

›INR for warfarin

›aPTT when heparin exposure suspected

›Type and screen when significant bleeding risk

Pregnancy and sexual assault related labs

›Pregnancy and sexual assault related labs

›Urine pregnancy test

›Guides imaging and medications

›Emergency contraception eligibility timing

›Baseline STI testing per protocol dependent

›NAAT for gonorrhea

›NAAT for chlamydia

›HIV testing baseline with consent

›Hepatitis B and C testing baseline with consent

Muscle injury and metabolic labs when indicated

›Muscle injury and metabolic labs when indicated

›CK

›Consider if prolonged immobilization

›Consider if extensive soft tissue trauma

›Urinalysis

›Hematuria suggests GU trauma

›Myoglobinuria suggests rhabdomyolysis

Toxicology and intoxication evaluation

›Toxicology and intoxication evaluation

›Point of care glucose

›Hypoglycemia mimic of intoxication

›Hyperglycemia in diabetics

›Blood alcohol level when clinically needed

›Urine drug screen limitations

›Does not exclude ingestion

›False positives possible

12Imaging/img53

Scoring Systems

›Scoring Systems

›Canadian CT Head Rule

›Adult minor head injury criteria

›Not for anticoagulated patients in some protocols

›New Orleans Criteria

›Alternative for minor head injury

›Higher imaging rates than Canadian CT Head Rule

›NEXUS C spine criteria

›Low risk rule out criteria

›Not reliable with intoxication or distracting injury

›Canadian C Spine Rule

›High sensitivity in alert stable adults

›Not for non trauma neck pain

›Ottawa Ankle Rules

›Reduces unnecessary ankle imaging

›Not for intoxicated or unreliable exam

MRI

›MRI

›Brain MRI

›Persistent focal deficits with negative CT

›Suspected diffuse axonal injury

›Cervical spine MRI

›Neurologic symptoms with normal CT

›Ligamentous injury concern

›Contraindications

›Non MRI compatible device

›Metallic foreign body risk

›CT

›CT head without contrast

›Concerning head injury features

›Anticoagulation with head trauma often lowers threshold per local protocol dependent

›CT cervical spine without contrast

›Neck pain with concerning mechanism

›Neuro deficits or midline tenderness

›CT angiography head and neck

›Strangulation with neurologic symptoms

›Expanding neck hematoma

›Carotid bruit after neck trauma

›CT chest abdomen pelvis with contrast

›Concern for internal injury

›Abnormal vitals or exam

›Contrast cautions

›Reduced kidney function

›Prior contrast reaction

Ultrasound

›Ultrasound

›eFAST

›Free fluid assessment

›Pneumothorax assessment

›OB ultrasound

›Pregnancy with abdominal pain or bleeding

›Dating for pregnancy risk counseling

›Soft tissue ultrasound

›Abscess versus hematoma

›Foreign body detection limitations

13Special Tests/spec19

Bedside maneuvers and functional tests

›Bedside maneuvers and functional tests

›Neurocognitive screen for concussion

›Symptom checklist

›Balance assessment if safe

›ABI for lower extremity vascular injury

›ABI less than 0.9 suggests vascular injury risk

›Normal ABI does not exclude all injury

›Ocular bedside evaluation when indicated

›Fluorescein staining for corneal abrasion

›Tonometry contraindicated if globe rupture concern

Forensic and safeguarding processes

›Forensic and safeguarding processes

›Sexual assault evidence kit timing per local protocol dependent

›Forensic photography per consent and policy

›Documentation standards

›Patient quoted statements when possible

›Injury description without speculation

›Mandatory reporting triggers

›Child abuse

›Vulnerable adult abuse

14ECG/ecg8

Indications and high risk patterns

›Indications and high risk patterns

›Chest trauma with pain or dyspnea

›Syncope or near syncope

›Stimulant use

›Known cardiac disease

›QT prolongation risk with medications

›New ischemic changes

›New arrhythmia

15Assessment/ax22

Problem list and severity

›Problem list and severity

›Injury burden summary

›Head injury severity

›Neck injury severity

›Chest and abdominal injury severity

›Extremity injury severity

›Strangulation risk stratification

›High risk features present

›Imaging and observation need

›Sexual assault care needs

›Prophylaxis eligibility

›Evidence collection preference

Safety assessment

›Safety assessment

›Safe discharge destination available

›Ongoing threat from assailant

›Dependents safety addressed

›Need for social work involvement

›Need for law enforcement involvement per patient preference and local laws

Diagnostic uncertainty and alternatives

›Diagnostic uncertainty and alternatives

›Occult internal injury despite benign exam

›Delayed airway edema after neck compression

›Delayed concussion symptoms

16Plan/plan26

First 5 minutes workflow

›First 5 minutes workflow

›Cardiac monitor if unstable or concerning mechanism

›SpO2 monitoring

›IV access criteria

›Two large bore IV if hypotension or major trauma concern

›IO access if unable to obtain IV in shock

›Oxygen criteria

›SpO2 less than 92 percent

›Respiratory distress

›Immediate hemorrhage control

›Direct pressure

›Tourniquet for life threatening extremity bleeding per local protocol dependent

›Early airway planning for neck compression red flags

Diagnostic sequencing

›Diagnostic sequencing

›Head and neck imaging based on decision tools and red flags

›FAST or eFAST in unstable patient

›Serial exams for abdominal injury concern

›Pregnancy testing before teratogenic medications or radiation when feasible

Therapeutics and procedures

›Therapeutics and procedures

›Analgesia

›Acetaminophen PO 1000 mg once

›Ibuprofen PO 400 mg once

›Avoid NSAIDs if active bleeding or high bleeding risk

›Wound care

›Irrigation volume adequate for contamination

›Closure decision based on contamination and

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Assault and Interpersonal Violence EvaluationAPPROACH

TRAUMA AND WOUNDS · 16 SECTIONS

⚲

562 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx84

Event details

›Event details

›Time since event

›Location and setting

›Number of assailants

›Known or unknown assailant

›Type of force

›Blunt

›Sharp

›Burn

›Bite

›Chemical exposure

›Weapons involved

›Firearm exposure

›Knife or sharp object

›Other weapon

›Ground level fall after assault

›Loss of consciousness

›Amnesia or confusion

›Substance use around event

›Alcohol

›Stimulants

›Opioids

›Sedatives

Strangulation specific history

›Strangulation specific history

›Manual neck compression

›Ligature neck compression

›Duration estimate

›Voice change

›Breathing difficulty during event

›Swallowing pain or difficulty

›Neck pain

›Neurologic symptoms

›Weakness

›Numbness

›Vision change

›Headache

›Incontinence during event

›Pregnancy status if relevant

Sexual violence exposure history

›Sexual violence exposure history

›Type of contact

›Oral

›Vaginal

›Anal

›Condom or barrier use

›Time since assault for prophylaxis windows

›Post assault bathing or clothing change

›Current genitourinary symptoms

›Bleeding

›Pain

›Dysuria

›Pregnancy risk

›STI risk concerns

Pain or focal symptom OPQRST

›Pain or focal symptom OPQRST

›Onset

›Sudden

›Gradual

›Provocation or palliation

›Worse with movement

›Worse with breathing

›Relief with rest

›Quality

›Sharp

›Dull

›Burning

›Region or radiation

›Primary location

›Radiation pattern

›Severity

›Current severity

›Peak severity

›Timing

›Constant

›Intermittent

Safety and social context

›Safety and social context

›Current safety

›Safe place to return

›Assailant access to patient

›Children or dependents at risk

›Elder or vulnerable adult concerns

›Police involvement preference

›Forensic evidence collection preference

›Past episodes of violence

›Threats to life

›Stalking or coercive control indicators

02Alarm Features/alarm47

Immediate life threats

›Immediate life threats

›Airway compromise

›Stridor

›Drooling

›Rapidly progressive neck swelling

›Respiratory compromise

›SpO2 less than 92 percent on room air

›Severe dyspnea

›Hemorrhagic shock

›Systolic BP less than 90 mmHg

›Altered mental status with hypotension

›Major hemorrhage

›Uncontrolled external bleeding

›Suspected internal bleeding

Neuro red flags

›Neuro red flags

›GCS less than 13

›Focal neurologic deficit

›Repeated vomiting

›Seizure

›Severe or worsening headache

›New confusion or agitation

Strangulation red flags

›Strangulation red flags

›Voice change

›Neck bruising or ligature marks

›Dysphagia or odynophagia

›Dyspnea

›Syncope or near syncope

›Petechiae of face or conjunctiva

›Focal neurologic symptoms

›Significant neck tenderness over larynx

Abdominal and chest red flags

›Abdominal and chest red flags

›Chest pain with trauma

›Absent breath sounds

›Crepitus

›Abdominal rigidity

›Rebound tenderness

›Seat belt pattern injury

›Hematemesis

Pregnancy and gynecologic red flags

›Pregnancy and gynecologic red flags

›Positive pregnancy test with abdominal pain

›Heavy vaginal bleeding

›Syncope with pelvic pain

›Concern for sexual assault with severe pain

Escalation triggers

›Escalation triggers

›If airway concern after strangulation, early anesthesia and ENT involvement

›If hemodynamic instability, trauma team activation per local protocol dependent

›If suicidal ideation, immediate mental health safety evaluation

03Medications/meds30

Current medications and interactions

›Current medications and interactions

›Anticoagulants

›Warfarin

›DOACs

›Antiplatelets

›Aspirin

›Clopidogrel

›Insulin and glucose lowering agents

›Antihypertensives

›Antiepileptics

›Psychiatric medications

›SSRIs

›Antipsychotics

›Chronic opioids

›Recent sedatives

›Benzodiazepines

›Z drugs

Analgesia and sedation considerations

›Analgesia and sedation considerations

›NSAID contraindications

›Kidney disease

›GI bleeding history

›Acetaminophen daily maximum

›Opioid risk factors

›Sleep apnea

›Concurrent sedatives

Sexual assault prophylaxis medication review

›Sexual assault prophylaxis medication review

›Hormonal contraception use

›Current pregnancy

›HIV PrEP use

›Hepatitis B immunization status

04Diet/diet8

Intake and fasting considerations

›Intake and fasting considerations

›Last oral intake time

›NPO considerations if procedural sedation anticipated

Substance and dehydration context

›Substance and dehydration context

›Alcohol intake recent

›Energy drinks or caffeine excess

›Poor intake due to stress or injury

›Vomiting or poor hydration

05Review of Systems/ros35

Neurologic and head

›Neurologic and head

›Headache

›Dizziness

›Vision change

›Weakness

›Numbness

›Memory gaps

Cardiopulmonary

›Cardiopulmonary

›Chest pain

›Shortness of breath

›Palpitations

›Cough

GI and abdominal

›GI and abdominal

›Abdominal pain

›Nausea

›Vomiting

›Blood in stool

GU and gynecologic

›GU and gynecologic

›Dysuria

›Hematuria

›Vaginal bleeding

›Pelvic pain

›Penile or testicular pain

Musculoskeletal and skin

›Musculoskeletal and skin

›Limb pain

›Joint swelling

›Back pain

›Wounds

›Burns

Psychological

›Psychological

›Acute anxiety

›Panic symptoms

›Sleep disturbance

›Hypervigilance

›Dissociation

06Collateral History and Family History/chafh14

Collateral sources and reliability

›Collateral sources and reliability

›EMS report

›Police report if available

›Family or friend account

›Shelter or community worker account

Family history

›Family history

›Bleeding disorders

›Early cardiovascular disease

›Seizure disorders

Social supports and dependents

›Social supports and dependents

›Safe contact person

›Dependent children safety

›Elder or vulnerable adult safety

›Housing stability

07Risk Factors/rf27

Medical risk modifiers

›Medical risk modifiers

›Anticoagulant use

›Bleeding disorder

›Pregnancy

›Older age

›Immunocompromise

Injury pattern risks

›Injury pattern risks

›Strangulation history

›Head strike

›High energy mechanism

›Penetrating injury

Violence recurrence and lethality risk

›Violence recurrence and lethality risk

›Escalating frequency or severity

›Threats with weapons

›Prior strangulation episodes

›Isolation from supports

›Assailant access to firearms

Sexual violence risk factors

›Sexual violence risk factors

›Unknown assailant

›Multiple assailants

›Mucosal exposure

›Delay to presentation affecting prophylaxis windows

Child and elder protection risk factors

›Child and elder protection risk factors

›Injuries inconsistent with history

›Delay in seeking care

›Poor supervision concerns

›Dependence on caregiver

08Differential Diagnosis/ddx67

Life threatening

›Life threatening

›Intracranial hemorrhage

›Anticoagulation increases risk

›Worsening headache or vomiting increases concern

›Cervical spine injury

›Midline neck tenderness increases concern

›Neurologic deficits increase concern

›Blunt cerebrovascular injury

›Strangulation with neuro symptoms increases concern

›Neck pain with focal deficits increases concern

›Laryngeal fracture or airway edema

›Stridor increases concern

›Voice change increases concern

›Pneumothorax or hemothorax

›Unilateral breath sound decrease increases concern

›Hypoxia increases concern

›Solid organ injury

›Abdominal tenderness increases concern

›Hypotension increases concern

›Compartment syndrome

›Pain out of proportion increases concern

›Pain with passive stretch increases concern

›Pregnancy related emergency

›Ectopic pregnancy (O00.9)

›Placental abruption (O45.9)

Common

›Common

›Concussion (S06.0X0A)

›Headache with normal imaging possible

›Symptoms can be delayed

›Contusion or hematoma (T14.8)

›Localized swelling and tenderness

›Anticoagulants increase expansion risk

›Laceration (S01 to S91)

›Infection risk by location

›Tendon or nerve injury as complication

›Fracture

›Point tenderness increases concern

›Deformity increases concern

›Sprain or strain

›Pain with range of motion

›Swelling without deformity

›Acute stress reaction (F43.0)

›Anxiety and insomnia

›Hyperarousal

Less common

›Less common

›Retinal injury

›Vision change

›Eye pain

›Rhabdomyolysis (M62.82)

›Prolonged immobilization

›Dark urine

›Toxic ingestion or intoxication

›Altered mental status

›Mixed substance exposure

›Occult vascular injury

›Expanding hematoma

›Distal ischemia

Mimics and pitfalls

›Mimics and pitfalls

›Medical syncope preceding injury

›Prodrome suggests syncope

›No clear assault mechanism

›Seizure preceding injury

›Tongue bite

›Postictal confusion

›Domestic violence underreporting

›Injuries in multiple healing stages

›Hesitant or inconsistent narrative

09Past Medical History/pmh18

Relevant conditions

›Relevant conditions

›Prior traumatic brain injury

›Prior strangulation episodes

›Seizure disorder (G40.909)

›Bleeding disorder (D68.9)

›Chronic kidney disease (N18.9)

›Diabetes mellitus (E11.9)

›Pregnancy history if relevant

Prior procedures and devices

›Prior procedures and devices

›Prior head or neck surgery

›Anticoagulation indication

›Implanted devices

›Pacemaker

›Vascular grafts

Baseline function and supports

›Baseline function and supports

›Baseline mobility

›Cognitive baseline

›Baseline mental health supports

10Physical Exam/exam69

Primary survey and vitals

›Primary survey and vitals

›Airway

›Voice quality

›Stridor

›Breathing

›Work of breathing

›Symmetry of chest rise

›Circulation

›Skin perfusion

›External bleeding

›Disability

›GCS

›Pupils

›Exposure

›Full skin survey with consent

›Temperature

Head and face

›Head and face

›Scalp hematoma

›Facial tenderness and deformity

›Oral trauma

›Dental injury

›Mucosal lacerations

›Eye exam when indicated

›Visual acuity

›Extraocular movements

Neck and strangulation findings

›Neck and strangulation findings

›Anterior neck tenderness

›Bruising or abrasions

›Ligature marks

›Tracheal deviation

›Laryngeal crepitus

›Carotid tenderness

›Cervical spine tenderness

Chest and cardiovascular

›Chest and cardiovascular

›Chest wall tenderness

›Rib crepitus

›Breath sounds

›Heart sounds

›Peripheral pulses symmetry

Abdomen and pelvis

›Abdomen and pelvis

›Tenderness by quadrant

›Guarding

›Distension

›Pelvic tenderness

›Flank ecchymosis

Extremities and neurovascular

›Extremities and neurovascular

›Deformity

›Range of motion limits

›Distal pulses

›Capillary refill

›Sensation

›Motor function

Neurologic

›Neurologic

›Cranial nerves screen

›Strength symmetry

›Sensory deficits

›Coordination

›Gait if safe

Skin and wound documentation

›Skin and wound documentation

›Injury mapping by location

›Size measurements

›Color and pattern description

›Photo documentation per policy and consent

›Forensic chain of custody considerations per local protocol dependent

Behavioral and mental status

›Behavioral and mental status

›Orientation

›Affect

›Intoxication signs

›Immediate safety concerns

11Lab Studies/labs35

Core trauma and bleeding risk labs

›Core trauma and bleeding risk labs

›CBC

›Anemia suggests bleeding

›Leukocytosis nonspecific

›Electrolytes and creatinine

›Kidney function for contrast decisions

›Baseline for medication dosing

›Coagulation studies when indicated

›INR for warfarin

›aPTT when heparin exposure suspected

›Type and screen when significant bleeding risk

Pregnancy and sexual assault related labs

›Pregnancy and sexual assault related labs

›Urine pregnancy test

›Guides imaging and medications

›Emergency contraception eligibility timing

›Baseline STI testing per protocol dependent

›NAAT for gonorrhea

›NAAT for chlamydia

›HIV testing baseline with consent

›Hepatitis B and C testing baseline with consent

Muscle injury and metabolic labs when indicated

›Muscle injury and metabolic labs when indicated

›CK

›Consider if prolonged immobilization

›Consider if extensive soft tissue trauma

›Urinalysis

›Hematuria suggests GU trauma

›Myoglobinuria suggests rhabdomyolysis

Toxicology and intoxication evaluation

›Toxicology and intoxication evaluation

›Point of care glucose

›Hypoglycemia mimic of intoxication

›Hyperglycemia in diabetics

›Blood alcohol level when clinically needed

›Urine drug screen limitations

›Does not exclude ingestion

›False positives possible

12Imaging/img53

Scoring Systems

›Scoring Systems

›Canadian CT Head Rule

›Adult minor head injury criteria

›Not for anticoagulated patients in some protocols

›New Orleans Criteria

›Alternative for minor head injury

›Higher imaging rates than Canadian CT Head Rule

›NEXUS C spine criteria

›Low risk rule out criteria

›Not reliable with intoxication or distracting injury

›Canadian C Spine Rule

›High sensitivity in alert stable adults

›Not for non trauma neck pain

›Ottawa Ankle Rules

›Reduces unnecessary ankle imaging

›Not for intoxicated or unreliable exam

MRI

›MRI

›Brain MRI

›Persistent focal deficits with negative CT

›Suspected diffuse axonal injury

›Cervical spine MRI

›Neurologic symptoms with normal CT

›Ligamentous injury concern

›Contraindications

›Non MRI compatible device

›Metallic foreign body risk

›CT

›CT head without contrast

›Concerning head injury features

›Anticoagulation with head trauma often lowers threshold per local protocol dependent

›CT cervical spine without contrast

›Neck pain with concerning mechanism

›Neuro deficits or midline tenderness

›CT angiography head and neck

›Strangulation with neurologic symptoms

›Expanding neck hematoma

›Carotid bruit after neck trauma

›CT chest abdomen pelvis with contrast

›Concern for internal injury

›Abnormal vitals or exam

›Contrast cautions

›Reduced kidney function

›Prior contrast reaction

Ultrasound

›Ultrasound

›eFAST

›Free fluid assessment

›Pneumothorax assessment

›OB ultrasound

›Pregnancy with abdominal pain or bleeding

›Dating for pregnancy risk counseling

›Soft tissue ultrasound

›Abscess versus hematoma

›Foreign body detection limitations

13Special Tests/spec19

Bedside maneuvers and functional tests

›Bedside maneuvers and functional tests

›Neurocognitive screen for concussion

›Symptom checklist

›Balance assessment if safe

›ABI for lower extremity vascular injury

›ABI less than 0.9 suggests vascular injury risk

›Normal ABI does not exclude all injury

›Ocular bedside evaluation when indicated

›Fluorescein staining for corneal abrasion

›Tonometry contraindicated if globe rupture concern

Forensic and safeguarding processes

›Forensic and safeguarding processes

›Sexual assault evidence kit timing per local protocol dependent

›Forensic photography per consent and policy

›Documentation standards

›Patient quoted statements when possible

›Injury description without speculation

›Mandatory reporting triggers

›Child abuse

›Vulnerable adult abuse

14ECG/ecg8

Indications and high risk patterns

›Indications and high risk patterns

›Chest trauma with pain or dyspnea

›Syncope or near syncope

›Stimulant use

›Known cardiac disease

›QT prolongation risk with medications

›New ischemic changes

›New arrhythmia

15Assessment/ax22

Problem list and severity

›Problem list and severity

›Injury burden summary

›Head injury severity

›Neck injury severity

›Chest and abdominal injury severity

›Extremity injury severity

›Strangulation risk stratification

›High risk features present

›Imaging and observation need

›Sexual assault care needs

›Prophylaxis eligibility

›Evidence collection preference

Safety assessment

›Safety assessment

›Safe discharge destination available

›Ongoing threat from assailant

›Dependents safety addressed

›Need for social work involvement

›Need for law enforcement involvement per patient preference and local laws

Diagnostic uncertainty and alternatives

›Diagnostic uncertainty and alternatives

›Occult internal injury despite benign exam

›Delayed airway edema after neck compression

›Delayed concussion symptoms

16Plan/plan26

First 5 minutes workflow

›First 5 minutes workflow

›Cardiac monitor if unstable or concerning mechanism

›SpO2 monitoring

›IV access criteria

›Two large bore IV if hypotension or major trauma concern

›IO access if unable to obtain IV in shock

›Oxygen criteria

›SpO2 less than 92 percent

›Respiratory distress

›Immediate hemorrhage control

›Direct pressure

›Tourniquet for life threatening extremity bleeding per local protocol dependent

›Early airway planning for neck compression red flags

Diagnostic sequencing

›Diagnostic sequencing

›Head and neck imaging based on decision tools and red flags

›FAST or eFAST in unstable patient

›Serial exams for abdominal injury concern

›Pregnancy testing before teratogenic medications or radiation when feasible

Therapeutics and procedures

›Therapeutics and procedures

›Analgesia

›Acetaminophen PO 1000 mg once

›Ibuprofen PO 400 mg once

›Avoid NSAIDs if active bleeding or high bleeding risk

›Wound care

›Irrigation volume adequate for contamination

›Closure decision based on contamination and

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.