Improving emergency department care of the sexual assault victin.

Victims of sexual assault face the multiple threats of disease, unwanted pregnancy, psychological trauma, and physical injury, which are further complicated by a comprehensive police investigation. An organized approach to the care of victims of sexual assault is presented, including guidelines for patient care and a discussion of police investigations, written consent forms, and physical evidence recovery kits. We recommend that the care of victims, from arrival in the emergency department until rehabilitation, be coordinated by a nurse. This specially trained individual serves as a liaison between the patient and the health professionals and police team.

Guidelines for supervised wound care by emergency nurse practitioners.

Nearly 10 million patients with traumatic lacerations are treated annually in Emergency Departments in the United States. Since these wounds do not usually pose a threat to the patient's life, they assume a lower level of priority than emergent conditions. Consequently, treatment of patients with lacerations is often delayed until the emergent patient is resuscitated. In the event that wound care is inadvertently delayed, bacteria may proliferate to levels that result in infection. In selected patients, supervised wound care by an emergency nurse practitioner (ENP) can safely eliminate this delay in treatment. During their graduate training in the University of Virginia Nursing School, the ENPs are instructed to treat traumatic wounds with physician supervision. The criteria for patient selection and care are outlined in comprehensive guidelines reported herein. The bases for these treatment guidelines were clinical and experimental studies conducted at our medical center which examined the influence of various therapeutic decisions on the ultimate fate of the wound.