WaqasQureshi
Forum Senior
Topics: 4
Posts: 177
|
If you have suspicion, YES YOU CAN DO IT. Why not?
Same case with a nurse. Usually nurses get needle sticks injuries and they come to the doctors and ask them to check a particular patient for his/her HIV status because they think that they might have got infected. You have to check for their status.
It is definitely about the consent but when the people are at danger, you can check HIV status obviously you cant force first but you have to ask the patient for it. Otherwise another patient would be created. Which is not ethically allowed. Plus you have to do a course of 3 drugs AZT, lamivudine and nelfinavir or idinavir for expanded regimen
|
| WaqasQureshi
Forum Senior
Topics: 4
Posts: 177
|
CDC guidelines are as under which is a 3 step process:
Step 1: Determine exposure code. Is the source material blood, bloody fluid, other potentially infectious material, or an instrument contaminated with one of these substances? If not, there is no risk of HIV transmission. If yes, what type of exposure occurred? If the exposure was to intact skin only, there is no risk of HIV transmission. If the exposure was to mucous membrane or integrity-compromised skin, was the volume of fluid small (ie, few drops, short duration) or large (ie, several drops or major splash, long duration)? If small, the category is exposure code 1. If large, the category is exposure code 2. If the exposure was percutaneous, was it a solid needle or a superficial scratch (ie, less severe)? If yes, the category is exposure code 2. Was it from a large-bore hollow needle, a device with visible blood, or a needle used in a source patient's artery or vein (ie, more severe)? If yes, the category is exposure code 3. Step 2: Determine HIV status code. What is the HIV status of the exposure source? If HIV negative, no postexposure prophylaxis is needed. If HIV positive, was the exposure low titer or high titer? Low-titer exposures are asymptomatic patients with high CD4 counts. These are HIV status code 1. High-titer exposures are patients with primary HIV infection, high or increasing viral load or low CD4 counts, or advanced acquired immunodeficiency syndrome (AIDS). These are HIV status code 2. If HIV status is unknown or the source is unknown, the HIV status code is unknown. Step 3: Match exposure code with HIV status code to determine if any postexposure prophylaxis is indicated. Postexposure prophylaxis recommendation Exposure code 1 and HIV status code 1: Postexposure prophylaxis may not be warranted. Exposure type does not pose a known risk. The exposed health care worker and the treating clinician should decide whether the risk for drug toxicity outweighs the benefit of postexposure prophylaxis. Exposure code 1 and HIV status code 2: Consider the basic regimen. Exposure type poses a negligible risk for HIV transmission. A high HIV titer in the source may justify consideration of postexposure prophylaxis. The exposed health care worker and the treating clinician should decide whether the risk for drug toxicity outweighs the benefit of postexposure prophylaxis. Exposure code 2 and HIV status code 1: Recommend the basic regimen. Most HIV exposures are in this category. No increased risk for HIV transmission has been observed, but use of postexposure prophylaxis is appropriate. Exposure code 2 and HIV status code 2: Recommend expanded regimen. Exposure type represents an increased HIV transmission risk. Exposure code 3 and HIV status code 1 or 2: Recommend expanded regimen. Exposure type represents an increased HIV transmission risk. HIV status code unknown: If the source or, in the case of an unknown source, the setting where the exposure occurred suggests possible risk for HIV exposure and the exposure code is 2 or 3, consider the postexposure prophylaxis basic regimen. Basic regimen: 4 weeks of zidovudine (600 mg/d in 2-3 divided doses) and lamivudine (150 mg twice daily) Expanded regimen: Basic regimen plus either indinavir (800 mg q8h) or nelfinavir (750 mg 3 times/d). Interferon ribavirin prophylaxis decreases risk by 40%. Exposed workers should be counseled on the risks of disease transmission based upon their specific exposure.
|
| WaqasQureshi
Forum Senior
Topics: 4
Posts: 177
|
Source patient (if available) HIV Hepatitis B antigen Hepatitis C antibody Aspartate aminotransferase/alanine aminotransferase (AST/ALT) and alkaline phosphatase levels Victim/health care worker Hepatitis B surface antibody HIV Hepatitis C antibody testing at 2 weeks, 4 weeks, and 8 weeks Prior to initiating retrovirals Pregnancy test (stat) CBC count with differential and platelets Serum creatinine/BUN levels Urinalysis with microscopic analysis AST/ALT levels Alkaline phosphatase level Total bilirubin level
|
| drms
Forum Senior
Topics: 12
Posts: 446
|
Great Waqas 
Thank u soo much
___________________
drms!dreams+responsibility+motivation=success!
|
| Eagle_303
Forum Elite
Topics: 34
Posts: 388
|
Suppose the patient refuses to get his HIV checked ,then ?
|
| Eagle_303
Forum Elite
Topics: 34
Posts: 388
|
It is the health care professional NOT the patient who is going to be tested .
CMDT :
[font style="background-color: #316ac5" color="#ffffff"]HIV[/font] Risk for Health Care Professionals
sustain needle sticks should be counseled and offered [font style="background-color: #316ac5" color="#ffffff"]HIV[/font] testing as soon as possible. [font style="background-color: #316ac5" color="#ffffff"]HIV[/font] testing is done to establish a negative baseline for worker's compensation claims in case there is a subsequent conversion. Follow-up testing is usually performed at 6 weeks, 3 months, and 6 months.
|
| WaqasQureshi
Forum Senior
Topics: 4
Posts: 177
|
if the patient refuses then the appropriate department will help you with it. you have to report it to the authorities. But the most appropriate step is that you ask the patient to get it tested. There can be many ASSUMPTIONS like patient might die next day etc. We arent concerned about what is GOING TO HAPPEN. We are concerned that what is MOST APPROPRIATE in the IMAGINARY WORLD OF USMLE!
|
| WaqasQureshi
Forum Senior
Topics: 4
Posts: 177
|
let me explain it a bit more. sorry Iam not good at explaining things though :$
its like when you do the contact tracing of STDs. You ask the patient to tell his/her partner. WE ARENT CONCERNED IF HE REFUSES. We are just doing our job. If he refuses, you go to the authorities. same way. If the patient refuses for HIV status check ... you go for authorities. They know how to get it done and they do it really well. Believe me!
|
| drms
Forum Senior
Topics: 12
Posts: 446
|
___________________
drms!dreams+responsibility+motivation=success!
|
| Eagle_303
Forum Elite
Topics: 34
Posts: 388
|
WaqasQureshi wrote:let me explain it a bit more. sorry Iam not good at explaining things though :$ its like when you do the contact tracing of STDs. You ask the patient to tell his/her partner. WE ARENT CONCERNED IF HE REFUSES. We are just doing our job. If he refuses, you go to the authorities. same way. If the patient refuses for HIV status check ... you go for authorities. They know how to get it done and they do it really well. Believe me!
Can you qoute any case in which patient who is competent refused to get himself check and authorities enforced him ??
Thanks in advance
|
|
| |
| | | | | | | | | | |
