Risk Management Pitfalls in the Management of Genital Injuries and Emergencies in Pediatric Girls
1. “This young girl has a labial laceration. She should have a surgical consult for immediate repair.”
Not every labial laceration requires surgical intervention. If the bleeding is controlled and the source of bleeding is determined to be external to the vaginal canal, the patient can be treated and given a disposition by the emergency clinician.
3. “This adolescent with hematocolpos already has a small tear in her hymen that is allowing bleeding. We can release the remainder of the blood here in the ED.”
A hymenotomy should never be performed in the ED. Due to the high risk of ascending infection, the procedure needs to be performed in the operating room under aseptic conditions.
4. “Since there are no external signs or symptoms concerning for a serious injury, I don't need to do any further workup on this child who fell on a toy.”
There are many instances in the literature where an impalement injury was missed due to lack of imaging and further investigation. Impalement injuries may be subtle, and if not treated immediately, may lead to peritonitis and bacteremia. At a minimum, further questioning regarding the appearance of the toy is warranted before making this determination.
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