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A 6-month-old infant is brought to the emergency department after a needle-stick injury. He was placed in a sandbox in a local park next to his older brother and he immediately started to cry. When the mother picked him up, she noticed a hypodermic needle sticking out from his pants. She removed it immediately, and rushed him to the hospital. The mother says that he has been very healthy and is up-to-date in his immunizations, including 3 hepatitis B, diphtheria tetanus and pertussis vaccines. The mother and father have no chronic medical conditions. Physical examination shows a clean puncture wound on his left buttock. The mother hands you the hypodermic needle from the sandbox. The most appropriate next step is to
A. administer diphtheria and tetanus toxoid and tetanus immune globulin
B. administer hepatitis B immune globulin
C. extensively debride the puncture wound
D. immediately test the syringe for HIV
E. obtain an immediate consultation with an infectious disease specialist
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answer is d
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He is already done with his DTp and Hepatitis B ,so I would go for D...
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Ccccc---
Just wonderin---how long does the needle need ot be exposed to air for the virus to die---this virud does not survive outside the body fluids--------
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ccccccccc....hiv does not survivewithout body fluids for more than few minutes
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same doubt in this question
Explanation:
The correct answer is E. Since this patient was injured by a discarded needle in the sandbox, you should obtain an immediate consultation with an infectious disease specialist to help determine if he should be given postexposure HIV prophylaxis. The issue of giving postexposure prophylaxis for HIV after a needle-stick injury from a discarded needle is controversial because there is very little data on this type of exposure, so an infectious disease specialist will be able to assess the risks and benefits.
Since this patient has already had 3 doses of the tetanus toxoid, it is unnecessary to administer diphtheria and tetanus toxoid and tetanus immune globulin (choice A) at this time. If he received 3 or more doses of tetanus toxoid, but it was more than 10 years since the last dose, he should be given dT. If his immunization status was unknown or if he received less than 3 doses, he should be given a dose of dT, but not immune globulin for a clean, minor wound. Individuals with unknown immunization status or less than 3 doses should be given dT and immune globulin for wounds contaminated with dirt, feces, soil, saliva, puncture and crush injuries and burns.
It is unnecessary to administer hepatitis B immune globulin (choice B), because he has completed the series of 3 vaccines. It is controversial whether or not the immune globulin is indicated in an incompletely immunized child.
It is inappropriate and unnecessary to extensively debride a puncture wound (choice C). It should be properly cleaned, examined and dirt should be removed.
According to the American Academy of Pediatrics and the Report of the Committee on Infectious Diseases, it is not reliable or practical to immediately test the syringe for HIV (choice D). It can also pose a risk to each handler.
