An 18-year-old female is brought to the emergency department by emergency medical services after being assaulted. She has sustained multiple injuries including abdominal contusions. She is alert, oriented, and complains of severe pelvic pain. Her vital signs are stable at the moment. On physical examination, there is significant bruising to the mons pubis and upper thighs, and ecchymosis of the labia majora. There is no vaginal bleeding or discharge noted. What is the most critical step for the emergency nurse to take next in the evaluation of this patient?
Order a complete blood count (CBC) to evaluate for anemia or thrombocytopenia.
Obtain an abdominal and pelvic CT scan immediately.
Notify social services and law enforcement for an incident report and potential forensic examination.
For a patient who has sustained blunt force trauma to the pelvic area with resulting pelvic pain and bruising, especially in the context of assault, it is imperative to conduct a thorough, chaperoned pelvic examination after initial stabilization. This examination will help identify any hidden injuries, such as hematomas or tissue laceration, that may not be immediately obvious but could have serious consequences if not promptly identified and treated. While notifying social services and law enforcement is very important for patient advocacy and legal documentation, it does not precede the emergency medical evaluation necessary to identify and treat potentially life-threatening or serious medical conditions. Obtaining an abdominal CT scan may be valuable for further evaluation but should follow the initial clinical examination. A complete blood count (CBC) may provide information about the patient's hematologic status but isn't as time-sensitive as the need for a pelvic examination in the current context.
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Gastrointestinal, Genitourinary, Gynecology, and Obstetrical
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