1. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1 Sexual Assault CAPT Mike Hughey, MC, USNR

2. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 2 Outline of Management Serious injuries first Brief history/consent Gather supplies Examine Treat (VD, Pregnancy)

3. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 3 Assign Staff Member Same sex Similar rank Remains with patient Psychological support Witness/Chaperone

4. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 4 CO, XO Officer of the Day Officer of the Deck Master at Arms NIS Notify the Command

5. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 5 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.

6. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 6 Gather your supplies before starting the exam. The patient will find delays in performing the exam to be tiresome. Supplies Sexual Assault Kit

7. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 7 Make up 25 Labels SN Susan Sailor, USN 123-45-6789 1 Jan 93, 0400 Fingernail Scrapings, Right Hand

8. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 8 Laboratory Requisitions Pregnancy Test VDRL or RPR HIV Hepatitis B 3 Gonorrhea Cultures Chlamydia Screen

9. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 9 Laboratory Specimens 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) You will never remember all this, so make sure to look it up.

10. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 10 Exam Equipment 1 vaginal speculum 1 pair latex exam gloves KY jelly Flashlight Camera and color film

11. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 11 Supplies: Patient Comfort Fresh clothing Mouthwash and cup Toothbrush and toothpaste Betadine douche Emesis basin Balboa Naval Hospital, San Diego

12. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 12 History Patient states she was raped at 0100 in Storage Room #3 today. Patient was raped by Senior Chief Antlerdance at 0100 today. X

13. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 13 Gynecologic History LMP Use of contraceptives Significant past gyne history Sexual History: -First IC? -Last prior IC

14. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 14 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

15. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 15 Photographs YOU are the photographer Abrasions, lacerations, contusions Color film May need 24 hours for contusions

16. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 16 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

17. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 17 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

18. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 18 Inspect and Palpate for Lacerations, Bruises, Abrasions Neck Back Abdomen Arms Legs

19. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 19 Have patient collect fingernail scrapings and place them in envelopes (right hand & left hand) Fingernail Scrapings

20. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 20 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

21. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 21 Toluidine Blue Dye Very helpful for identifying fresh trauma Apply, then rinse with vinegar Dye is taken up by metabolically active cells. Without DyeWith Dye

22. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 22 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

23. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 23 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

24. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 24 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 Pregnancy: Substitute Erythromycin 250 mg PO QID x 7 days for Doxycycline

25. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 25 Emergency Contraception 2 Ovrals 12 Hours Later 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 Within 72 hours:

26. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 26 Followup Exam 1-2 weeks: -Assess psychological adaptation -Repeat pregnancy test if no menses 4 weeks: -VDRL -Hep B -HIV -Physical exam

27. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 27 Release from Medical Department Never go home alone Accompanied by someone she knows and trusts Goes to a safe place

28. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 28