Body Fluid Exposures Workup

  • Author: Nathalie Mathieu, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Aug 25, 2010
 

Laboratory Studies

Testing for HBV, HCV, and HIV is recommended at the time of injury. This is useful, primarily as baseline evaluation, because patients would not have undergone seroconversion in such a short time frame.

Though a number of states require written informed consent for HIV serologic testing, in the event a patient is unable to consent for himself or herself, some institutions allow surrogates to sign. Surrogates may be family members, legal guardians, or 2 attending physicians.

In the instance where a source patient refuses to consent, some states waive the required informed consent.

Many clinicians obtain routine laboratory evaluations, such as a complete blood cell count and chemistries, which likely are not of much value acutely, but are important as baseline values. However, sending rapid plasma reagent (RPR) and human chorionic gonadotropin (if pregnancy status is unknown) would be prudent because their prognostic value can be reasonably high in these cases.

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Imaging Studies

Acutely, imaging studies are of little use, unless the presence of a foreign body or radiopaque material is suspected.

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Procedures

The single most pertinent procedure to undertake in the patient after exposure is lavage. Copious amounts of irrigation fluid are appropriate in cases of mucosal exposure (ocular and oral), as well as soap and water washing in cases of needlestick injury. Although no regimen has been shown to affect viral transmission rates, this is an empiric regimen aimed at decreasing the level of exposure to the viral agent and, thereby, decreasing the associated risk of transmission.

Small wounds and punctures may be cleansed with an antiseptic such as an alcohol-based hand hygiene agent. Alcohol is virucidal to HIV, HBV, and HCV. Other agents that inactivate HIV are iodophors, chloroxylenol, and chlorhexidine.[10]

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Contributor Information and Disclosures
Author

Nathalie Mathieu, MD  Resident Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Joel R Gernsheimer, MD, FACEP  Visiting Associate Professor, Department of Emergency Medicine, Attending Physician and Director of Geriatric Emergency Medicine, State University of New York Downstate Medical Center

Joel R Gernsheimer, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Samuel M Keim, MD  Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Barry J Sheridan, DO  Chief, Department of Emergency Medical Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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Flowsheet for management of blood/body fluid exposures.
 
 
 
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