Reference no: EM133714214

Problem

Sarah is a 22 year-old white female who was escorted to the emergency department by her boyfriend at 0120 with a chief complaint of extreme pelvic pain (9/10) and significant vaginal bleeding. When asked about the bleeding, Sarah does not answer, but her boyfriend says it started about an hour prior and stated no precipitating causes. Her physical exam showed signs of bruises and contusions to her abdomen, arms and thighs. Her abdomen is slightly rounded, soft and non-distended. Abdominal sounds are present; the bleeding has slowed on exam is scant

Emergency department staff responds to immediate physiologic needs. Sarah's nurse asks the client if she is pregnant. Sarah, appearing horrified, shakes her head "no." Her boyfriend becomes visibly agitated. When the nurse attempts to find out more information, the boyfriend exclaims, "She doesn't have anything to say! She just started bleeding, why don't you do something?

The whole story: Sarah was being trafficked by the man that brought her to the hospital pretending to be her boyfriend. Earlier that evening Sarah was meeting a client. During their time together, the client had become highly aggressive so Sarah attempted to leave. When she did, the client used a set of keys to molest her. Upon vaginal speculum examination, deep lacerations were seen in her vaginal wall, causing the bleeding.

1) Now knowing the whole picture, would you change anything about how you approached the patient interaction?

2) What did you originally assume was going on in this situation? - Intimate Partner Violence? Rough sex?

3) If the vaginal trauma had been less severe, do you think sex trafficking would be considered a possibility? Unless providers are aware of sex trafficking, patients may not receive much-needed assistance.

4) How would you assess the safety of yourself and your patient in this type of situation?

5) What resources could you, as the nurse, use in this situation?