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HIVAND THE SURGEON

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HIVAND THE SURGEON Powered By Docstoc
					HIV AND THE
SURGEON

      Dr.K.Bujji Babu
  Consultant HIV Physician
   Dr.Bujjibabu HIV Clinic
UNIVERSAL PRECAUTIONS


SURGERY IN HIV PATIENTS


MORBIDITY AND MORTALITY


OCCUPATIONAL TRANSMISSION
     UNIVERSAL
    PRECAUTIONS
1983 BLOOD AND BODY FLUID
PRECAUTIONS
PTS KNOWN TO OR SUSPECTED TO
HAVE INFECTIONS
REALISATION THAT MANY
ASYMPTOMATIC
? TAILOR TO DEGREE OF
ANTICIPATED EXPOSURE
  CARDINAL RULES
CONSIDER ALL PATIENTS
INFECTIOUS
ASSUME ALL BODY FLUIDS
CONTAMINATED
ASSUME ALL UNSTERILE SHARPS
AS INFECTIOUS
IDENTIFY RISKS BEFORE STARTING
PROCEDURE
LOW RISK EXPOSURE
CONTACT WITH SKIN WITH NO
VISIBLE BLOOD
INJECTIONS
MINOR DRESSINGS
GLOVES HELPFUL BUT NOT
MANDATORY
     MEDIUM RISK
      EXPOSURE
POSSIBLE CONTACT WITH BLOOD
SPLASH UNLIKELY
INSERTION REMOVAL OF CANNULAE
LARGE OPEN WOUND DRESSING
INTUBATION
GLOVES MUST
GOWN OR APRON MAY BE NECESSARY
      HIGH RISK
PROBABLE CONTACT WITH
BLOOD,SPLASH OR
UNCONTROLLED BLEEDING
MAJOR SURGERY
VAGINAL DELIVERY
GLOVES + WATERPROOF GOWN
+EYE WEAR + MASK + SHOES
        GLOVES
NOT 100% SAFE
MANUFACTURERS ACCEPTABLE
LEAK RATE 1.5%
VOLUME OF BLOOD INJECTED BY
SOLID NEEDLES DECREASE BY
70%
2 GLOVES FURTHER 50%
REDUCTION
   PREVENTION OF
INJURY FROM SHARPS
DON’T RECAP NEEDLES
USE A TRAY TO HAND SHARPS
DO NOT BEND SHARPS
PROPER DISPOSAL IN SHARPS
CONTAINER
HIGH RISK SURGERIES
DENTAL
ORTHOPAEDIC
OBSTETRIC AND GYNAE
COLORECTAL
UNIVERSAL TESTING IS NOT A
SUBSTITUTE FOR UNIVERSAL
PRECAUTIONS
   POST EXPOSURE
    PROPHYLAXIS
BASIC PEP ZIDOVUDINE 300 mg BD
+LAMIVUDINE 150mg BD FOR 28
DAYS
EXPANDED PEP ADD INDANAVIR
800mg TID OR NELFINAVIR 750mg
TID
REPEAT TESTING 6 WKS , 3 AND 6
MONTHS
     LYMPH NODES
AS FAR AS POSSIBLE FNA
ONLY 2 SITUATIONS BIOPSY
TO CLASSIFY LYMPHOMA
FNA NEGATIVE NODE WHICH
ENLARGES OR WITH UNEXPLAINED
SYSTEMIC ILLNESS IN THE PATIENT
           ITP
HIV ASSOCIATED ITP DOES NOT
RESPOND WELL TO STEROIDS
POST SPLENECTOMY SIGNIFICANT
RISE IN CD4 COUNTS AND
PLATELETS
    ABDOMINAL
LYMPHADENOPATHY
AND ORGANOMEGALY
LAPAROSCOPY PREFFERED FOR
BIOPSY
ONLY 8-10% OF HIV +ve PATIENTS
WITH ACUTE ABDOMINAL PAIN
REQUIRE EMERGENCY SURGERY
ANORECTAL SURGERY
ANAL CONDYLOMATA
PERIANAL ABSCESSES AND
FISSURES
ANAL CANAL CA
   POST SURGICAL
   COMPLICATIONS
LOW MUSCLE MASS
LOW CD 4 DELAYED HEALING
LOW CD 4 INCREASED SEPTIC
COMPLICATIONS
     RISK AFTER
    OCCUPATIONAL
      EXPOSURE
HOLLOW NEEDLES 0.3%
5 FOLD INCREASE IF BLOOD ON
NEEDLE
6 FOLD INCREASE IF HIGH VIRAL
TITRE
16 FOLD INCREASE IF NEEDLE
PENETRATES DEEPLY
NON HOLLOW NEEDLES
CHANGES IN SURGICAL
    TECHNIQUE
AVOIDANCE OF HAND TO HAND
PASSAGE OF SHARPS
BLUNT NEEDLES FOR FASCIAL
CLOSURE
NEEDLE HANDLING ONLY WITH
INSTRUMENTS
LAPAROSCOPY-- ? DROPLETS ON
EVACUATION OF PNEUMO
MANDATORY
PREOPTESTING
NONOPERATIVE
TREATMENT
THANK YOU

				
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posted:4/4/2011
language:English
pages:22