QI have a scene where my heroine, a crime scene cleanup person, is jabbed with a bone fragment at a relatively fresh scene (shotgun death). What kind of treatment would she receive once she arrived at the hospital? Besides stitching the wound, would it be cleaned a specific way? If the victim was suspected to be HIV positive, would my heroine immediately begin a cocktail of drugs, and if so, could you name the drugs? Would there be a delay in beginning meds while they waited for the coroner to determine if the victim was indeed HIV positive? If so, how long would it take to get confirmation?
WR
Surrey, British Columbia, Canada
AThe initial treatment in the emergency room would be fairly standard for any puncture wound by a foreign body. They would clean the wound and give her a tetanus shot if she had not had one in the past five to ten years. There would be no suturing since puncture wounds are best left open to heal inside out as this lessens the chance of a wound infection. They might or might not place her on antibiotics for the next five to seven days. That would depend upon the exact nature of the injury and the decision of the treating physician in the ER.
Because she was stabbed by a biological product, in this case a bone fragment, she would likely receive hepatitis B immunization since this can be a dangerous disease and is transmitted by blood. Chances are great that this would be done.
As far as treating her for HIV, this is controversial in a circumstance where the puncturing object might or might not be infected. Some docs would; others would wait for the gunshot victim’s blood to be tested. But this could be done fairly quickly. Hours to a day at the most. A puncture of this type is of course very concerning, but it does not absolutely mean that she will get HIV.
If the test was positive, she would be treated for HIV exposure with one or more of the protease inhibitor drugs. There are several of them, and there are many treatment protocols that are constantly changing as our knowledge about HIV treatment evolves, so I can’t give you an answer as to exactly what drugs would be used. If the test was negative, they would still perform an HIV test on her in the ER, repeat it in three months, and repeat it again in six months just to be safe. If all of those are negative, then she did not contract the disease at the time of her injury. If any one of these tests is positive, she would be treated as any other HIV patient.