needlestick scenario
candidate brief
You are seeing a 27yo SHO doctor who has presented to ED after sustaining a needlestick injury on her night.
40% history taking 40% communication 20% clinical reasoning
actor brief
You are a medical SHO on nights who was taking blood from a ward patient when you sustained a needlestick injury. You immediately stopped, washed your hands and went down to ED. All you know about the patient is that they were an IVDU being treated for endocarditis.
PMH anxiety
DHx sertraline
NKDA
You are concerned as you remember someone in med school who was infected with HIV after a needlestick injury.
You had your Hep B vaccinations in med school, you can't remember exactly when
examiner brief
- takes appropriate history re nature of exposure
- when this occurred
- how it occurred – clean needle/dirty needle/bite, bloods/body fluids
- first aid measures
- wound sustained - drawn blood?
- Asks about source patient:
- HIV status, viral load
- Hep B status, surface antigen status
- Hep C status, viral load
- If unknown what is known that would increase risk (Sub-Saharan, African, MSM, IVDU, Sex worker)
- Enquires if source patient has given consent for bloods
- Asks about patient's PMH, DHx
- Asks about patient's vaccination history (Full course of HBV vaccination or non responder?)
- Explains suggests Hep B vaccination or booster, and accelerated course, depending on vaccination status
- If not vaccinated against Hep B and high risk (HBsAg +ve), offers HB Immunoglobulin
- advises appropriate investigations
- serum save
- consent and bloods from source patient taken by another HCP
- recognises high risk patient
- advises re risk of transmission for blood borne viruses
- elicits questions
- empathetic manner
- advises re investigations needed now: serum save
- agrees management plan with patient
- appropriately counsels for PEP
- advises re safe sex
- appropriate f/up - Occ Health
Adapted from Tom Bircher's stations 2019 http://accssurvivor.net/ed/osce-practice/ and MRCEM Part C 125 OSCE stations
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