Sexual assault in ED

  • SARCs are great, but they can't deal with acute injury and illness.
  • Safeguarding issues?
  • Most senior/qualified doctor should do the assessment (make the first time the best time)

investigations

  • bloods → chain of custody
  • avoid swabs - can disrupt evidence
  • treat as any trauma

ED interventions

  • emergency contraception
    • Up to 72 hours after the assault offer Levonorgestrel 1.5g as a stat dose (Levonelle).
    • Ulipristal acetate (EllaOne) and copper intrauterine contraceptive device (Cu-IUD) are licensed for use as emergency contraception for up to 5 days, and where EC is indicated you should advise that Cu-IUD is the most effective form of emergency contraception
    • If BMI > 26 or weight >70kg, offer ulipristal acetate or a double dose (3g) of levonorgestrel as normal dose levonorgestrel
  • Other post-exposure treatment