dilemma (from Korean medical drama)

[sejin8642]

There was a situation where surgeons had to perform a surgery on a seriously traumatized patient but the patient was infected HIV. If you perform a surgery, there are huge possibilities that you are to be infected HIV since blood would squirt all over your body (the hospital was so small that they did not have necessary equipments for treatment of AIDS patient). But if you do not perform the surgery, the patient will most likely die. If you encounter a situation like this, what would be your response? I just brought this thing since this kind of question could also come up during interviews.

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[ocwaveoc]

My response would be that even the smallest hospitals would have equipments to protect the healthcare workers from contact isolation patients. As long as the surgeon is well covered with the rudimentary protective clothing/gloves, the likelyhood of getting infected is small. Therefore, I'd take a chance and operate since the odds are on my favor and that to operate on someone like that in such a situation is all the more reason why one may become a surgeon. Of course, if the situation is such that even one drop of blood on your skiin from an AIDS patient can infect you, I'd reconsider. But that's not how you get AIDS.

 

[Dr. C. Troy]

Three words: Full Body Condom

The question seems kinda silly. Unless you were dragged through a razor-blade store a few hours prior to surgery, you wouldn't have huge chances for contamination unless you slipped up and cut yourself and got the patient's blood in your wound, or stuck yourself with a suture during closure. Your average surgery doesn't involve cutting or sticking yourself, however.

Realistically, there doesn't seem to much of a dilemma here.

 

[ocwaveoc]

I agree with Dr. Troy. Sejin, you must have a huge misconception of how one gets infected with AIDS virus. Haha...I'd make sure I know things like that before you go on interviews.

 

[sejin8642]

Three words: Full Body Condom

The question seems kinda silly. Unless you were dragged through a razor-blade store a few hours prior to surgery, you wouldn't have huge chances for contamination unless you slipped up and cut yourself and the patient, or stuck yourself with a suture during closure.

Realistically, there doesn't seem to much of a dilemma here.

The situation in the drama was much more complicated. As soon as everyone in the hospital found out there were an AIDS patient among them, every patient left and no surgeon and nurse are willing to volunteer for the operation beside two male and female surgeons. I mean the situation was awful and I can't describe it well. And guess what? As soon as main artery that had been squeezed were uncovered, blood suddenly squirted into the surgeon's face. And i don't know what happened after that.

BTW, some of you guys caught some odds that i didn't. It was unprofessional that the surgeons were not properly equipped. It's just drama and some twist must happen.

 

[nacho libre]

The situation in the drama was much more complicated. As soon as everyone in the hospital found out there were an AIDS patient among them, every patient left and no surgeon and nurse are willing to volunteer for the operation beside two male and female surgeons. I mean the situation was awful and I can't describe it well. And guess what? As soon as main artery that had been squeezed were uncovered, blood suddenly squirted into the surgeon's face. And i don't know what happened after that.

Good point. That same question was brought up at two of my interviews.

Also another relevant situation that everyone might encounter: The patient was shot with a Civil War era explosive which is still lodged in his abdomen. The problem is an EMT worker has her hand in the patient and on the explosive. The movement of the hand could cause the bomb to go off. Merideth Gr-I mean you are the doctor attempting to perform on the patient, when suddenly the EMT slips her hand out. Do you slip your hand in it's place? If you encounter a situation like this, what would be your response? I just brought this thing since this kind of question could also come up during interviews.

 

[sejin8642]

You guys might be able to check this drama on youtube. Try search for "Surgeon Bong Dal Hee." I am not sure if the subtitles are present.

 

[smq123]

The situation in the drama was much more complicated. As soon as everyone in the hospital found out there were an AIDS patient among them, every patient left and no surgeon and nurse are willing to volunteer for the operation beside two male and female surgeons. I mean the situation was awful and I can't describe it well. And guess what? As soon as main artery that had been squeezed were uncovered, blood suddenly squirted into the surgeon's face. And i don't know what happened after that.

BTW, some of you guys caught some odds that i didn't. It was unprofessional that the surgeons were not properly equipped. It's just drama and some twist must happen.

In this specific scenario:
Despite popular belief, HIV is not a very infectious virus. Even if you accidentally stick yourself with a needle that was used on a patient with AIDS, you have a very small chance [1/300] of being infected. (Hepatitis B, however, is a whole different story.) Getting splashed with HIV infected blood (unless you have oozing, open sores on your skin) is an even smaller risk. In real life, if there was any accidental exposure to HIV infected blood, taking a massive dose of anti-retroviral drugs will help prevent the virus from replicating before it can spread all over your body and go into hiding. It's not as big a deal as you're making it out to be.

In general:
If you're firmly convinced that your life is endangered by treating a patient, you don't have to do it. If you know that intervention wouldn't help the patient, then you don't have to help. This is why the Red Cross and the UN don't set up shelters in the middle of war zones.

But, personally, if I thought that I could save the patient and the chance of saving the patient was higher then the chance that I'd be infected with HIV, then, sure, I'd do it.

Moral of the story: Get your Hep B vaccines! Hep B is much more infectious that HIV, and although Hep B usually isn't chronic, you don't want to run that risk.