Question re: PEP and Occupational Exposures
May 10, 2009
Hi Dr Frascino,
I'm a medical student who is worried about a potential occupational exposure. This evening when I was taking a train to meet some friends a man had a seizure and collapsed in front of me. I assisted him and after slowly declining in conscious state over a few minutes he ceased breathing. I cleared his airways and performed CPR for approximately five minutes, where upon he resumed spontaneous respiration and regained consciousness. He refused any further medical treatment once the train had stopped and an ambulance arrived. The man in question was obviously intoxicated and had obvious signs of IV drug abuse - multiple track marks, etc. After the incident, I noticed that I had several recent cuts on the fingers I used to clear his airway - fresh red tissue was still visible, but the wounds were not actively bleeding. While I noticed no frank blood in his mouth or on on my hands, the fact that he had a seizure and fall (potentially striking/biting himself) in combination with his obvious history of IVDU had me concerned. I attended a nearby hospital and asked for recommendations regarding the incident. They took blood for baseline antibody tests and stated that PEP was not necessary. While the realist in me knows that the chances of 1: him having a blood borne virus and 2: it being transmitted to me via the route in question are both very low, I still find myself extremely worried about the situation.
Your opinion on this incident would be greatly appreciated, as I view your perspective as perhaps the most down to earth and honest of any expert online. I've used your site before as a resource for educating others about HIV - I suppose I find myself now looking for some reassurance more than anything else. While I realise that you are extremely busy, any response would be very welcome.
Response from Dr. Frascino
Hi Worried Medical Student,
First of all congratulations on presumably saving seizure-guy's life! Many medical students would not have acted so decisively. BRAVO.
Regarding your HIV-acquisition risk, I agree with the assessment you were given by the hospital: Your HIV risk was negligible at best. PEP is definitely not warranted.
At this point my only advice is to stop worrying (easier said than done, I realize). Get your follow-up HIV tests. The odds are astronomically in your favor that you did not contract HIV while being a Good Samaritan.
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