Trauma informed care and consent
›Care approach
›Private setting
›Patient control over pacing
›Consent for each step
›Support person presence if desired
›Interpreter use when needed
Forensic and reporting pathways
›Forensic pathway
›SANE or forensic examiner consult if available
›Evidence collection window local protocol dependent
›Law enforcement contact patient choice unless mandated
Infection prophylaxis and vaccines
›Empiric STI prophylaxis adults and adolescents CDC guideline based
›Ceftriaxone IM single dose
›500 mg IM once
›1000 mg IM once if weight 150 kg or more
›Doxycycline
›100 mg PO twice daily
›Duration 7 days
›Avoid in pregnancy
›Metronidazole
›500 mg PO twice daily
›Duration 7 days
›Avoid alcohol during and after per local protocol
›Hepatitis B prevention
›Hepatitis B vaccine if not immune
›HBIG plus vaccine if assailant hepatitis B positive and patient not immune
›HPV vaccine
›Initiate or continue series per age and local protocol
HIV post exposure prophylaxis
›HIV PEP decision making
›Initiation as soon as possible
›No later than 72 hours after exposure
›Risk assessment based on exposure type and local prevalence
›HIV PEP regimen examples local protocol dependent
›Tenofovir DF emtricitabine daily plus dolutegravir daily
›Tenofovir disoproxil fumarate 300 mg PO daily
›Emtricitabine 200 mg PO daily
›Dolutegravir 50 mg PO daily
›Duration 28 days
›Bictegravir tenofovir alafenamide emtricitabine single tablet daily
›Use per local protocol and guideline availability
›Duration 28 days
›HIV PEP safety and monitoring
›Baseline creatinine and liver enzymes
›Medication interaction check
›Antiemetic as needed
›Emergency contraception
›Levonorgestrel
›1.5 mg PO once
›Best as soon as possible
›Ulipristal acetate
›30 mg PO once
›Avoid with immediate hormonal contraception restart per local protocol
›Copper IUD
›Within 5 days local protocol dependent
›Consider if high efficacy desired and resources available
Symptom control and injury care
›Analgesia
›Acetaminophen 1000 mg PO once
›Ibuprofen 400 mg PO once
›Wound care
›Clean and dress abrasions
›Tetanus update per vaccination status
›Reassessment timing
›Repeat vitals after interventions
›Pain reassessment
›Anxiety and distress reassessment
›Safety plan reassessment before discharge