Patient’s self-inflicted wounds may become infected.

The patient may not be able to communicate his needs properly, become frustrated, and potentially urinate or defecate in an undesirable area.

Administer antibiotics and wound care as needed/prescribed to decrease the risk of the patient’s wounds getting infected.

A referral to a speech therapist may be needed to increase communication and social interaction, as well as eye contact in order to build trust and communicate his needs. A referral to an occupational therapist may be needed to facilitate better elimination patterns, and social behaviors.

Inform patient of anticipated transfer as soon as possible. Make sure to gradually introduce the patient to the idea, and necessary stimuli. Use visual schedules, pictures, or stories to help the child better understand the transfer process. Make sure comfort items are included, and keep the child’s routine as structured and normal as possible.

Contact the case manager to help with the transfer, and collect the necessary documents, and make sure all are in order.

S (Situation):

Jimmy, a 10-year-old boy with Autism Spectrum Disorder (ASD), is brought to the ER by his mother for self-injurious behavior. He has been hitting his head against walls at school and floors at home for the past 3 days, resulting in a swollen bruise with localized edema on his forehead. He has also been biting his hands, breaking the skin, and attempted to bite the family dog. The mother reports that Jimmy has difficulty communicating his needs due to being nonverbal, and he is easily frustrated when his routine is disrupted.

B (Background):

- Diagnosis: Autism Spectrum Disorder (ASD)

- Communication: Nonverbal, uses a communication device

- Behavioral Concerns: Severe communication deficits, social skills deficits, poor bowel and bladder control, self-injurious behaviors (head hitting, biting).

- Presenting issue: Self-injurious behavior (head hitting, hand biting) for 3 days with associated injuries.

- Past medical history: No specific details provided regarding other health conditions.

A (Assessment):

- Physical examination:

- Swollen bruise and localized edema on the forehead

- Multiple open lesions on both hands consistent with human bites

- No significant distress noted with vital signs:

- Heart rate: 118 bpm (tachycardic)

- Blood pressure: 120/88 mmHg (normal)

- Respiratory rate: 24 (within normal limits)

- Temperature: 37.5°C (low-grade fever)

- Oxygen saturation: 99% on room air

- Mental state: Jimmy appears frustrated, nonverbal, and unable to communicate effectively. His behavior is likely exacerbated by his inability to express his needs.

R (Recommendation):

- Immediate pain and wound management:

- Clean and dress hand lesions to prevent infection (human bite wounds).

- Assess and treat the head injury (bruise/edema) to rule out any underlying concussions or trauma.

- Evaluate for underlying causes of behavior:

- Consider assessing for infection, discomfort, or environmental stressors that may be triggering the self- injurious behaviors.

- Behavioral support:

- Consult with psychiatry or behavioral health to assess the need for interventions such as medication or behavioral therapy to manage aggression and frustration.

- Consider involving a child life specialist to help with communication and calming techniques.

- Monitor for any further escalation in self-harm or behavioral changes.

- Educate the mother on managing Jimmy’s behavior at home and provide resources for supporting his communication and social needs.

Jennifer Lopez

Victoria Menchaca

Andrea Moore

Karen Recillas

Nahlah Rodriguez

Jacqueline Salinas

Felicia Vavricka