An 11-year-old girl presents to the urgent care with complaints of vaginal bleeding. She states that the bleeding started 2 days ago following a bicycle accident where she landed on the handlebars. Physical examination reveals tenderness and bruising in the perineal area with active vaginal bleeding. What is the best treatment plan for this patient?
- Continue observation and expectant management with close monitoring.
- Initiate hormonal therapy to regulate bleeding, as well as prescribe antibiotic therapy to prevent infection.
- You give her 200 mg of ibuprofen and treat the area with gauze and ice packs. You offer her water and wait to discharge until after she urinates.
- Refer the child to the ED for immediate surgical intervention to repair the vaginal laceration.
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Answer: C. Given the history of a bicycle accident and the physical findings, a straddle injury is the most likely diagnosis. After administering age-appropriate pain medication (eg, acetaminophen or ibuprofen), you applied direct pressure to the bleeding area with sterile gauze and ice packs. You aren’t able to discharge this patient until after she has urinated, so you inform her mother that she may need to be immersed in water to prevent stinging and additional pain. You also tell Mom that if she can’t urinate or the bleeding continues, she will need to go to the ED for a urology or gynecology consultation, depending on the suspected injury (vulvar hematoma, urethral injury, anal sphincter injury, or vaginal laceration). Discharge instructions include follow-up with urology/gynecology specialist.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
