Sexual abuse: The Daily PANCE Blueprint

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Sexual abuse: The Daily PANCE Blueprint

A 29-year-old female with no remarkable medical history presents to the ER about 2 hours after a sexual assault during which she was penetrated vaginally. Vitals are unimpressive. She provides consent to proceed with a physical exam. On physical exam, you see multiple bruises on her arms and legs. Pelvic examination shows erythema of the vulva and vagina. Labs are pending at this time. Which of the following is the best next step in management?

A. Administer HPV vaccination
B. Order CT abdomen/pelvis for further work-up
C. Order for intravenous antibiotics and admit
D. Prescribe ceftriaxone, azithromycin, and metronidazole
E. Prophylaxis against herpes simplex virus

Answer and topic summary

The answer is D. Prescribe ceftriaxone, azithromycin, and metronidazole

Sexual violence is the use of force (physically or psychologically) as a means to obtain a sexual act from another individual; it is a crime if committed against people who don’t consent. The most appropriate setting for the care of these patients is the ER or a local rape crisis center. A primary survey should be performed first and then a forensic evaluation should be done by a sexual assault nurse examiner (SANE) or sexual assault forensic examiner ((SAFE). All patients who have experienced sexual assault should be offered testing for STIs and given empiric prophylaxis for STIs (e.g., ceftriaxone, azithromycin, metronidazole), hepatitis B prophylaxis and HIV post-exposure prophylaxis (depending on the patient’s profile), and offered emergency contraception.

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Covered under ⇒ PANCE Blueprint Psychiatry ⇒ Abuse and Neglect ⇒ Sexual abuse

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