Gynecology

Question:

You are called to examine a 17 year old female who presented to the emergency room 12 hours after a straddle injury while riding a bicycle. She is complaining of being light headed and extreme vulvar pain. Her physical examination reveals a pulse of 140 beats per minute and blood pressure of 70/40 and a temperature of 39.0 degrees Celsius (102.2 degrees Fahrenheit). Physical examination demonstrates the perineum, vulva and mons pubis to be slightly purple, swollen and tender with crepitus and a purulent discharge. The next appropriate step is:

	intravenous antibiotics and monitoring
	incision and drainage of the vulva
	intravenous antibiotics and hyperbaric oxygen therapy
	hyperbaric oxygen therapy alone
	intravenous antibiotics and radical vulvar debridement