Pediatric emergency medicine trisk 4245 4245
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management. A pregnancy test must be performed and negative prior to
administration. It is offered within 120 hours of an assault with vaginal
penetration or genital contact with ejaculation occurred. Progestin-only
emergency contraceptive pills are most favorable in terms of safety, adverse
effects, and efficacy. A total of 1.5 mg of levonorgestrel can be taken once,
with or without ondansetron to mitigate nausea and/or vomiting. Emergency
contraception is up to 90% effective in pregnancy prevention. No studies to
date show untoward effects on the fetus should pregnancy occur; it does not
disrupt an already implanted pregnancy. Pregnancy testing should be
repeated at 2 weeks.
Reporting
Physicians and other healthcare professionals are mandated reporters under
U.S. law, and therefore, are required to report suspected as well as known
cases of child abuse ( Table 127.6 ). In many states, the suspicion of child
sexual abuse as a possible diagnosis requires a report to both the appropriate
law enforcement and CPS agencies. For many children who present with
complaints of sexual assault, CPS and the police may have already been
involved; however, some children present prior to contact with these
agencies. Medical providers need to be aware of their mandated reporter
status and the associated obligation to report any suspicions of child abuse.
The threshold for reporting is low; if there is a reasonable suspicion of
sexual abuse, a report is indicated. The CPS agency then has the
responsibility to conduct a thorough investigation to determine whether the
abuse has occurred. Mandated reporters are protected against criminal or
civil repercussions for any report made in good faith, no matter the eventual
outcome of that investigation.
