What additional questions should the practitioner ask about the wound?

For wounds and lacerations, it is important to obtain a detailed history (Dunphy et al., 2022).  Questions should include how the injury occurred, if there is a potential for a foreign body to be present in wound, if underlying tissue is injured, when the wound occurred, tetanus vaccination status, any known allergies, and known comorbidities (Dunphy et al., 2022).  Comorbidities such as diabetes or vascular problems are important because it increases the patient’s risk of infection and slows wound healing (Dunphy et al., 2022). 

What testing should the practitioner consider for the wound?

Given the presenting symptoms and appearance of the wound such as red, inflamed, warm to the touch, green/yellow drainage, painful to touch, and the patient’s temperature of 100.5, I would suspect infection.  A wound culture and CBC with diff should be considered (Dunphy et al., 2022). 

What treatment should be provided to the wound?  If you prescribe a medication, provide full prescription details.

After wound cultures are performed, the first treatment would be to cleanse the wound using normal saline irrigation, 50 to 100ml of saline per centimeter of wound length (Dunphy et al., 2022).  The wound should be kept clean, dry, and covered using a thin layer of antibiotic ointment (Dunphy et al., 2022).  Topical ointment such as mupirocin may be used adjunctively in bacterial skin infections, mupirocin 2% ointment – apply TID to wound for 10 days (Arcangelo et al., 2021).  Wound dressing should be changed daily or if the dressing is wet or dirty (Dunphy et al., 2022).  For wounds with established infection, and if the patient does not have an existing allergy, parenteral therapy ampicillin/sulbactam, cefoxitin, or ceftriaxone, then followed with oral antibiotic therapy for 7 to 10 days with cephalexin or cefadroxil (Dunphy et al., 2022).  The orders would be Ceftriaxone (Rocephin) 1G IM once for infection, followed by cephalexin (Keflex) 500mg PO Q6hrs for 10 days for infection (Arcangelo et al., 2021).  I would advise patient to start treatment, and she may need to switch antibiotics pending culture results. 

What signs suggest that this may be an abuse and human trafficking situation?

Signs that this may be an abuse and human trafficking situation include the male staying with her at all times and answering questions for her, his harsh treatment towards her, her outfit that does not fit the outside temperature, multiple bruises on her thighs and arms at various stages of healing, and lacerations on forearms.  There is no typical presentation of these victims.  Lack of eye contact, deferring conversation to their companion, lack of belongings, unexplained injuries, bruising, scars, open wounds, fractures, burns, and head injuries can be seen in victims of human trafficking (Dunphy et al., 2022). 

What further assessment should the practitioner perform?

Initial treatment for victims of suspected human trafficking should include crisis intervention, physical and psychiatric evaluation.  The practitioner should use basic statements to build trust and not interrogate the patient (Dunphy et al., 2022).  Questions to ask include if the patient would like to talk in private, the last time she saw a doctor or went to the hospital, who the man is with her, where is she staying, does she have an ID, what sort of work does she do, does she have a cell phone (Dunphy et al., 2022).  Over 80% of sex trafficking survivors received medical care while being trafficked for various conditions including injuries, neurological and cardiovascular issues, reproductive health issues, and mental health, which is why providers need to be able to identify and aid these victims (Sayles et al., 2024). 

Who should the practitioner involve in the care to assist in assessing for human trafficking and in providing support to the woman?

The practitioner should involve the National Human Trafficking Hotline, which can provide information for local resources including shelters, law enforcement, and other resources.  The hotline is answered by a live person 24 hours a day (Dunphy et al., 2022).  This patient is not a minor, so reporting sexual exploitation is not federally mandatory.  Having a social worker, justice advocate, or volunteer who specializes in sex trafficking assist with assessment can help obtain additional information (Emergency Physicians Monthly, n.d.). 

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