CASE 9 - Assault

Question 1

This is all my fault, doctor. Do you think my friends will ever accept me again?

Answer 1

I am so sorry for what happened to you. It is horrific and must be very difficult for you to handle.

However, it is not your fault by any means.

Whoever did this to you should be held accountable.

Question 2

Specific questions to ask:

Answer 2

1. Incident location.
2. Recognize assailants?
3. Report the incident?
4. Description of assault.
5. Assault objects.
6. Sexual assault? Condoms? Ejaculation? Type of intercourse?
7. Foreign objects used?
8. LMP? Contraceptives?
9. Vaginal bleeding?

Question 3

PEx:

Answer 3

1. HEENT ==> I + P.
2. Mouth ==> I.
3. CV ==> A.
4. Pulmonary ==> I + A + P + P.
5. Abdo ==> I + A + P.
6. Neuro ==> Mental status + CNs + Gross motor.
7. Musculoskeletal ==> I + P.

Question 4

Sample closure:

Answer 4

1. Ms. Melton, I am really sorry for what happened to you.
2. I want to emphasize that it is not your fault, and you should not feel guilty about it. I recommend that you report the incident to the police.
3. In the meantime, I will need to do a pelvic exam to make sure you have no injuries in the genital area.
4. In addition, I will need to collect some specimens and swabs from your body and genital area so that they can be used as evidence if you choose to file charges, and also to look for STDs.
5. We will run some blood tests for potential STDs and will order a pregnancy test and some x-rays.
6. If your pregnancy test is negative, we will offer you some options for emergency contraception.
7. It would also be prudent to give you some antibiotics to protect you from infections.
8. Finally, I can have our social worker come talk to you and provide you with phone numbers for support groups and other resources.

DYHAQFM

Question 5

DDx 1 — Rib Fracture:

Answer 5

1. Physical assault.
2. R chest pain.
3. Pain is exacerbate by movement and deep breaths.
4. Tenderness on palpation of R chest wall.

Question 6

DDx 2 — STD:

Answer 6

1. Sexual assault by 2 men.

2. No condom use.

Question 7

DDx 3 — Pregnancy:

Answer 7

1. Unprotected vaginal intercourse with possible ejaculation.
2. No OCP use.
3. LMP 3weeks ago.

Question 8

Workup:

Answer 8

1. Pelvic exam.
2. XR-skeletal survey.
3. CXR.
4. Urine hCG.
5. Wet mount, KOH prep, cervical culture, gonorrhea and chlamydia tests.
6. HIV antibody, VDRL, HBV antigen.

Question 9

Additional DDx:

Answer 9

1. Pneumothorax/hemothorax.

2. Muscle rupture.