1 Female and Male Sexual Assault Flashcards
Emergency contraception is most effective when started within
72 hours of assault
remarks on extraction of pubic hair samples
Begin the genital exam with combing of the pubic hair and **extraction of hair samples.
Patient can pluck their own hair, but make sure that the hair root is included
used to highlight microtrauma
toluidine blue dye
- a dye with affinity for DNA and RNA
drugs that are typically though of as “date rape” drugs
ketamine
flunitrazepam (Rohypnol)
y-hydroxybutyric acid
Roypnol can be detected in the urine for up to 72 hours, and y-hydroxybutyric acid can be detected for 12 hours
test for these in sexual assault victims
syphilis, hepatitis B and C, and HIV
Testing for gonorrhea, chlamydia, and bacterial vaginosis is not necessary, because treatment is provided at the ED encounter
Follow baseline HIV testing with repeat testing when?
at 6 weeks and 3 and 6 months
obtain serum chemistry, liver function studies, and CBC for patietns who will receive HIV postexposure prophylaxis.
CDC recommended regimens for infection prophylaxis in sexual assault
Ceftriaxone 250mg IM, single dose
PLUS
Azithromycin, 1 g PO, single dose
PLUS
Metronidazole, 2g PO , single dose
OR
Tinidazole 2 g PO single dose
Emergency contraception regimens
- Levenorgestrel (Plan B®)
- Combined estrogen-progestin (Yuzpe®)
- Mifepristone
- Ulipristal acetate (Ella®/Fibristal®)
Dose of Levenorgestrel
(Plan B®)
1.5 mg once
or
0.75 at 1 and 12 hours
Dose of Combined estrogen-progestin
(Yuzpe®)
100 mcg ethinyl estradiol
plus
0.50 mg levenorgestrel
at 1 and 12 h
Dose of Mifepristone
25-50 mg pO as a single dose
Dose of Ulipristal acetate
(Ella® / Fibristal®)
30 mg PO as a single dose
Emergency contraception with lowest estimated pregnancy risk
Mifepristone
(1-10 / 1000 estimated pregnancy risk)
menstrual dealy most common side effect
most significant factor predicting failure of emergency contraception
cycle day of intercourse
most significant factor determining HIV infectivity
viral load in the assailant