Sexual Assault

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Sexual Assault
CAPT Mike Hughey, MC, USNR
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Outline of Management

• Serious injuries first
• Brief history/consent
• Gather supplies
• Examine
• Treat (VD, Pregnancy)

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Assign Staff Member

• Same sex
• Similar rank
• Remains with patient
• Psychological support
• Witness/Chaperone

4
Notify the Command
CO, XO Officer of the Day Officer of the
Deck Master at Arms NIS
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Obtain Consent For

• Exam and Treatment
• Collecting Evidence
• Releasing Reports Evidence
• Taking Photos (if indicated)

If consent is withheld, defer to higher
authority. While you may have the right to order
an examination, that is not always the wisest
decision.
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Supplies
Gather your supplies before starting the
exam. The patient will find delays in performing
the exam to be tiresome.
Sexual Assault Kit
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Make up 25 Labels
SN Susan Sailor, USN 123-45-67891 Jan 93,
0400Fingernail Scrapings, Right Hand
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Laboratory Requisitions

• Pregnancy Test
• VDRL or RPR
• HIV
• Hepatitis B
• 3 Gonorrhea Cultures
• Chlamydia Screen

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Laboratory Specimens
You will never remember all this, so make sure to
look it up.

• 2 pieces of filter paper
• 2 red-top tubes
• 2 wooden toothpicks
• 2 pieces plain white paper
• 3 Gonorrhea plates
• Chlamydia Screen Kit

• 3 glass slides/slide holders
• 1 tongue blade
• 2 combs
• 9 paper envelopes
• 6 twin-packs of Q-tips
• 5 ml distilled water (not saline)

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Exam Equipment

• 1 vaginal speculum
• 1 pair latex exam gloves
• KY jelly
• Flashlight
• Camera and color film

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Supplies Patient Comfort

• Fresh clothing
• Mouthwash and cup
• Toothbrush and toothpaste
• Betadine douche
• Emesis basin

Balboa Naval Hospital, San Diego
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History
Patient states she was raped at 0100 in Storage
Room 3 today.
Patient was raped by Senior Chief Antlerdance at
0100 today.
X
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Gynecologic History

• LMP
• Use of contraceptives
• Significant past gyne history
• Sexual History -First IC? -Last prior IC

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Clothing

• Let any stains dry
• Place in PAPER bag
• Seal Label the bag
• Give to MAA or NIS
• Chain of Custody Form
• Property Receipt to patient

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Photographs

• YOU are the photographer
• Abrasions, lacerations, contusions
• Color film
• May need 24 hours for contusions

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Head Combings

• Lightly comb patient's hair over white paper
• Fold comb and hairs into paper
• Place in envelope
• Label and seal it
• Chain of Custody

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Mouth Exam

• Tongue blade Flashlight (trauma)
• GC (swab and GC plate)
• Saliva swab and smear
• Glass slide (air-dry)
• Swab air-dry and seal in envelope
• Filter paper
• Soaked with saliva
• air-dry
• don't touch it with your fingers

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Inspect and Palpate for Lacerations, Bruises,
Abrasions

• Neck
• Back
• Abdomen
• Arms
• Legs

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Fingernail Scrapings
Have patient collect fingernail scrapings and
place them in envelopes (right hand left hand)
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Pelvic Exam

• Chlamydia Culture
• Gonorrhea culture
• Vaginal Swab
• Glass slide smear, air-dry
• Swabs air-dry, seal in envelope
• Don't look for motile sperm unless you have been
  trained to do this

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Toluidine Blue Dye

• Very helpful for identifying fresh trauma
• Apply, then rinse with vinegar
• Dye is taken up by metabolically active cells.

Without Dye
With Dye
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Blood Urine Tests

• VDRL or RPR
• Hepatitis B - ( 1 month)
• HIV - ( 1 month and 6 months)
• HCG - (weekly until next menses)
• 1 Extra red-top tube for MAA or NIS
• 4-5 drops of patient's blood on filter paper and
  let dry

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Risk of Acquiring STD

• Risk of GC is 6-12
• Risk of Chlamydia is a little higher
• Risk of syphilis is about 3
• Risk of pregnancy from single exposure during the
  middle 2 weeks of the menstrual cycle is 8
• Risk of AIDS unknown but very small

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Antibiotic

• Ceftriaxone 125 mg IM, plus
• Doxycycline 100 mg PO BID 14
• Zithromax 1 gm PO
• Flagyl 2 gm PO
• Spectinomycin 2 gm IM, plus
• Doxycycline 100 mg PO BID 14
• PregnancySubstitute Erythromycin 250 mg PO QID
  x 7 days for Doxycycline

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Emergency Contraception
Within 72 hours
2 Ovrals
12 Hours Later
2 Ovrals

• No abnormal bleeding.
• 50 have nausea and vomiting.
• Reduces pregnancy risk by 75. (8 to 2)
• Theoretical concern over exposure.
• We don't know how it works.
• May use 4/4 LoOvral, 4/4 Nordette, 4/4 Levelen

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Followup Exam

• 1-2 weeks -Assess psychological adaptation
  -Repeat pregnancy test if no menses
• 4 weeks -VDRL -Hep B -HIV -Physical
  exam

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Release from Medical Department

• Never go home alone
• Accompanied by someone she knowsand trusts
• Goes to a safe place

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