ID: Katya is a 28-year old from Kharkiv, Ukraine.
Police: Patient was caught in a brothel & they think she is the Madame running the place. There were 2 other buildings with brothels nearby which were also caught in the undercover sting operation. A man is with her, who claims to be her uncle. The patient looked like she was about to faint, so she was brought to the ER.
Social Work: Patient came to NYC to study at Columbia University. She escaped the bombing in Kharkiv, to Kiev. But then she decided to study in the US since the war did not stop. She went on a date with a Russian-speaking man she met at the supermarket, since he also had been born in Kharkiv. At the end of their date, he walked her into an alley & took her to dimly lit hotel to meet more "friends." They turned out to be to a group of men who stole her passport & she became trapped in a Russian- & Eastern European-speaking underworld in NYC. They put her in charge of 3 hideaway homes filled with Russian- & Ukrainian-speaking girls, who were similarly trapped, & forced to work as prostitutes. They put her in charge of running this operation.
- VS: RR 28, T 98, HR 105, BP 110/90.
- PE highlights: well-dressed, blue bruises on dorsal right & left wrists.
- Gyne/OB: IUD: no displacement, no PID, ovary, vaginal, or uteral tenderness, erythema, or injury.
- Psych highlights: patient avoids the man's eyes who calls himself "uncle," & is LEP. Thought: Tangential; attention: distracted; affect: blunted; speech: slow & halting, low volume; memory unknown if intact. Delayed circadian rhythms, weight gain >20 lbs,
- Labs: Blood tests, LFTs, UA, Pregnancy blood test: beta hCG, vaginal culture, NATs (detects HIV RNA), antigen/antibody combination tests (detects HIV p24 antigen & HIV IgM & IgG antibodies), antibody tests (detects HIV IgM &/or IgG antibodies), QuantiFERON-TB Gold Plus.
Diagnoses: PTSD & Depression (until labs arrive)
ANSWER THESE QUESTIONS IN DEPTH:
1 - In what order will the relevant health professionals see her?
2- What injuries, verifications, or conditions will be most urgent?
Step by step
Solved in 4 steps
