> Hi,
> Ive been following this thread with interest (but have missed some
> replies, so apologies if Im repeating someone). Im unsure
> where the problem
> lies with risk assessment and PEP prescribing.
>
> We are the Emergency department.
>
> Assessment of a needle stick is an Emergency.
As is AAA repair
>
> Starting PEP is an emergency invervention - again this is
> something we do.
This is where the problem lies: Routinely prescribing anti retraviral drugs
is not something we do. These drugs have fairly common life threatening
sided effects, and have numerous cautions. Maybe its the population I cover,
but in my experience patients want to know what the side effects of the
drugs are, what their risks are and what the risk of HIV is in this
particular circumstance before taking the drug (I honestly don't see enough
of it to keep up to date with local HIV infection rates in the various at
risk groups or the percentage risks of the side effects of the various
drugs- I am a simple emergency physician, moderately at home with trauma and
critically ill patients but not the best person to treat patient outside my
small field). The GUM consultants know more about this than I do. If I
worked in total isolation I'd accept reading out the guidance to the
patients, admitting my ignorance and leaving the decision to them. I however
have the backup of consultants in other specialties who know more than I do.
Taking on PEP just because it is an emergency is no more laudable than
trying to patch up your own AAAs in the resus room. If another specialty is
clearly better than A and E at something, leave it to them both within and
outside hours- lets take on things that we excel at (soft tissue trauma,
initial resuscitation of multiple trauma, critically ill patients, things
that need doing in the first 15 minutes of the patient coming through the
door as opposed to the first couple of hours) rather than acting as the out
of hours juniors to other specialties.
Matt Dunn
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