dangerous patients

[drboris]

Advertisement - Members don't see this ad

I had a quick question for all the ER experts. How do ER docs deal with very dangerous patients: altered, TB, HIV, etc.

It seems that besides the nice lifestyle and good pay, ER docs in trauma 1 hospitals must always worry about their own safety. A patient can have TB and the doc might not find out until after he has been coughed all over. Likewise, a patient may start severely bleeding all over the doc, and then reveal that he has Hepatits or HIV.

Everything about ER sounds really good to me, but this issue overshadows all the brightspots.

Thanks a lot!

 

[Idiopathic]

Universal precautions and PEP would be my guess.

 

[e2kschultz]

That's part of the job. Not just for ER docs, but for any doc that works in a clinic, surgeons, etc. ER docs are probably more vigilant about precautions because you never know what's rolling through the door, what's being breathed or bled upon you, but it happens to all of us all the time.

I've never heard of anyone actually catching anything, and the statistics on workplace exposure to diseases actually show the risk is pretty minor. The irritating, anxiety filled part is when you get stuck you have to take HIV meds, or immunizations, whatever and pray you don't seroconvert.

 

[sweetfynesse]

Originally posted by drboris
I had a quick question for all the ER experts. How do ER docs deal with very dangerous patients: altered, TB, HIV, etc.

...

Everything about ER sounds really good to me, but this issue overshadows all the brightspots.

Thanks a lot!

Just curious if this concept also applies to your sex life....

But all jokes aside, as an EM resident those are issuses that you think about, and as Idiopathic stated, universal precautions are a must. I've treated severeal HIV/AIDS pts, and it definitly forces me to be even more anal with my procedures or blood draws. And you're right, sometimes bad things happen to good people, but the actual rate of seroconversion with a needle stick is very low-that's not to say it doesn't happen...but almost any medical field has risks. You just have to be aware of them, and learn how to combat them....

 

[Sessamoid]

IIRC, the rates of infectious disease contraction is highest among surgeons than other specialties. We're up there, but not nearly as high as the surgeons. I know a doc that converted from a needlestick in a clinic (granted this was an HIV clinic), and that was terribly sad. But with modern therapy, that doc is still alive and running marathons nearly 10 years later. HIV isn't the short-term death sentence it once was, and PEP is pretty effective. Hep C worries me more since there's still no effective PEP and no effective treatment.

Even if you're an ER doc, chances are you won't be working in a Lev 1 trauma center anyway (there just aren't that many of them). Even if you do, most of the invasive procedures will be done by the surgeons anyway.