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Student Exposure- Please Help
Aug 21, 2007

Dr. Bob,

First and foremost you are truly an inspirational man and a true healer. Secondly I have a situation which has been taking a great toll on my life. 6 weeks ago during my er rotation a young man came into trauma with a finger laceration which needed to be sutured. My attending assisted me and while we were irrigating the wound out, the attendant filled a syringe with normal saline or sterile water- not sure which one it was and he pushed it into the wound it splashed back up onto my face and hit me in the eye as well. The splash was not massive. However, I am upset because this particular attending I feel mislead me. He gave me an ETOH pad to wipe my face with and didn't let me wash my eye(s) right out but instead wanted me to finish the suturing so I did. ( being timid and all). Anyway, at the time I didn't think much of it because nothing had happened to me while on rotations thus far. Well 4 weeks later I developed a sudden sore throat, swollen glands, headache and my tongue was red. I tested for strept and it was negative. I thought about the esposure so I flipped out on this particular day and filed an incident report. I began feeling very tired, decreased appetite and extremely depressed. I had an orasure rapid test at the hospital because i was still on my er rotation and it was negative. the next week ( 5 weeks post-exposure) I developed a runny nose, congestion, headache and some muscle pains. I did an elisa blood test which came out negative. The patient's status was unknown. Please tell me if I should be concerned? Are these symptoms ARS? Is the 4 week and 5 week tests pretty conclusive in this case? I'm sorry for all the questions but I am so upset that protocol was not followed and that i did not have the chance to test patient, get pep and do things the right way. I have truly lost a lot of time over this. The higest temperature I got was 99.3 on first day of symptoms but then 98.8 taken on same day.

Response from Dr. Frascino

Hi,

I agree your attending should have allowed you to rinse out your eye and file an incident report at the time of the potential exposure. All medical school training programs have strict policy and procedures in place for potential exposure to bloodborne pathogens. That said, I strongly doubt PEP would be indicated for such an incident such as the one you describe.

Regarding "symptoms," remember they are notoriously unreliable in predicting who is and is not HIV infected. I agree you should follow the routine testing procedure guidelines. Your odds of seroconverting from this incident remain negligible, but not completely nonexistent. As you are a medical student, I suggest you download and read the "Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Post-Exposure Prophylaxis." You can download the document at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm. You should also discuss this entire incident and your concerns with the director of your training program. Someone (not you) should have a serious "talk" with that attending physician!

Dr. Bob



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