Police transport a 22-year-old G0P0 woman to the emergency room after she was sexually assaulted.
Topic: Sexual Assault
Police transport a 22-year-old G0P0 woman to the emergency room after she was sexually assaulted. According to the early information, the woman was attacked by a male attacker she met at a home party. She stated that she does not utilize any sort of contraception and is not sexually active. She was forced to engage in vaginal penetration of the penile while being threatened with a knife, but she didn’t have any subsequent memory loss or loss of consciousness. Upon examination, the patient shows signs of anxiety, tears, and minor wounds. Her heart rate is 90 beats per minute, blood pressure is 130/70 mmHg, and she is afebrile.
?What are the priorities in the management of this patient?
?What special approach must be undertaken in the examination?
?What infections are most likely to be acquired?
?What medications (if any) should be offered?
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According to Secor et. al. (2019), the initial priorities in the management of a sexual assault patient are the facilitation of safety and emotional stability. Determination of the timeline for assault is also important. Following consent from the patient, a qualified sexual assault nurse examiner, or physician should perform a physical assessment. When the assault has occurred within the previous 5 days, a forensic examiner should be involved in the examination so that materials can be obtained that can help identify the perpetrator. Documentation should include history of the assault in the patient’s own words. Special care must be taken with all gathered material for evidence, such as clothing, documentation with pictures of any injuries, and preservation of bodily fluids.
The patient’s medical and gynecological history should be taken, for risk or presence of pregnancy. When it has been less than 5 days, prophylaxis should be offered against STI’s and pregnancy. If more than 5 days have elapsed. testing for STI’s and pregnancy should be offered.
The possible infections that can be transmitted and medications for treatment are as follows (Secor, et. al.):
Chlamydia- Doxycycline 100 mg po BID x 7 days
Gonorrhea- Ceftriaxone 500 mg IM, or 1 G IM for patients weighing over 150 kg
Hepatitis B- Hepatitis B vaccination if not already immunized or if perpetrator stus is positive, then Hep B vaccine and HBIG initially, then at 1-2 months and 4-6 months
HPV- HPV vaccine if not already immunized for women up to age 45, and at 1-2 months, then at 6 months
HIV- HIV PEP depending on the case and history
Trichomoniasis_ Metronidazole 500mg po BID x 7 days
The patient may also be at risk for pregnancy and should be offered ella, plan B or copper T-IUC within 5 days of the sexual assault.
The assault is mandated to be reported to the police, depending on the state.
Follow-up with mental health counseling and appropriate community help programs should be offered, and discharged with family or friends.
References
Secor, R. M., Holland, A. (2019). Advanced health assessment of women. pp 440-442. Springer Publishing.
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