SEXUAL ASSAULT

A   21-year-old university  student presents    to  the emergency   department

stating she was walking home    after   an  evening class   when    she was

assaulted   by  a   male    stranger    and was raped.  She is  not crying  or  upset,  but

rather  looks   almost  without emotions.   She is  accompanied by  her female

roommate.

Definition. Rape is defined as sexual activity without the individual’s consent
occurring under coercion.

Management.

Stabilization.  The first   step    is  to  determine   the patient’s   vital   signs   and take

whatever    is  needed  to  stabilize   them.   An  informed    consent needs   to  be

obtained.

History-taking. Record  the events  that    happened    in  the patient’s   own words.

Also    obtain  a   reproductive,   obstetric,  sexual, and contraceptive   history.

Examination.    A   thorough    general and pelvic  examination should  be

performed   with    photographic    or  drawing documentation   of  any injuries    or

trauma.

Specimens.  A   rape    kit should  be  used    to  obtain  biologic    specimens   (e.g.,

vaginal,    oral,   or  anal    specimens)  for DNA or  other   evidence    for use in

potential   legal   proceedings.    These   must    be  appropriately   labeled and

documented, including   signatures  of  receiving   authorities.    Also    obtain

baseline    laboratory  tests:  VDRL,   HIV screen, pregnancy   test,   urine   drug

screen, and blood   alcohol level.