Matt,
The analogy with repairing a AAA repair is silly - and I dont think it
reflects the point I was making. I wouldnt put assessing a needle stick in
the same analogy with taking a AAA to OT. I could accept the initial
assessment of a AAA.
I dont agree Matt (obviously). We prescribe and administer all sorts of
drugs infrequently with a whole collection of potential serious
side-effects. PEP is just another set of drugs. I'm famililar enough with
the drugs to provide an overview of how they work and the frequency of their
side-effects. I also feel comfortable providing the first 2-3 doses until
they are reviewed by sexual health or the ID team. I dont see that as been
the "junior" to any speciality, any more so than providing the initial
management to a patient who is going to OT as a "junior" to the surgeons. We
deal in the initial management of emergencies.
Im not suggesting that if you have no experience or training with something
that you should do it, but in my personal opinion assessing needlesticks,
doing a basic risk assessment, +/- starting PEP and then refering to the ID
or Sexual health for ongoing management for further care is core Emergency
medicine. If the situation is tricky or complicated, and I feel out of my
depth Id ask for advice, just like I do in other situations. But I work in a
hospital where we frequently see needle sticks - both in healthcare workers
and other unfortunates.
There are obviously different philosophical approaches to what is EM, and
where our boundaries are. I obviously see them slightly different to you.
Again, just my opinions
cheers
Craig
>From: "Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY - SwarkHosp-TR"
> <[log in to unmask]>
>Reply-To: Accident and Emergency Academic List <[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: Post exposure prophylaxis HIV
>Date: Sat, 3 Nov 2001 04:31:00 -0000
>
> > 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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