PCMO Supply Preparation for Managing Assault

Attachment A

Provide Appropriate Setting and Furniture (In Office)

Room (private, quiet, access to toilet)
Examination Table
Light source (exam lamp)
Magnifying instrument (magnifying glass and/or colposcope)
Exam Supplies (In Office and Go Bag)
Plastic disposable vaginal speculums; various sizes & battery operated light source for speculum
Universal precautions supplies: gloves, sharps container, etc.
Individually-packaged sterile cotton tipped applicators
Tape measure and ABFO ruler
Sterile suture kit for lacerations
Gown or cover while examining patient
Office pregnancy tests (Quik-Tests)
Office HIV rapid tests
Light source (flashlight, pen light)
Camera
magnifying glass
Toluidine blue dye 1%- this is not mandatory only if available
Acetic acid or water soluble lubricant to remove toluidine blue dye from skin
Do Not Disturb sign for the door
Needles, syringes, red top tube and purple top tubes
Assortment of bandaging materials, gauze, and tape for wounds
Stethoscope and BP cuff for vital signs
Go Bag for supplies
SAK (Sexual Assault Kit)
Office Binder with country-specific sexual assault information
Drugs (In Office and Go-Bag)
Ceftriaxone 250mg IM + Lidocaine 1% as diluent
Doxycycline 100mg po or Azithromycin 1 gm po
Metronidazole 2 gm po or Tinidazole 2 gm po
Plan B One Step (Levonorgesterel 0.75 mg po X2 tabs)
Tigan 200mg supp or pill three times a day (for nausea)
Hepatitis B vaccine or Hepatitis B Immune Globulin 0.06ml/kg IM
Azithromycin 2gms poX1 (if allergic to PCN/Ceftriaxone)
Truvada 200mg/300mg po X28 tabs(qd X28 days) + Isentress 400mg po X 56 tabs (bid X28 days)

February 2015