It was clear the situation was more serious than another routine incision and drainage: the patient was cold, sweating profusely, and pale as the hospital sheets. I’d thought that now, post-medical school finals, I’d be raring to go in an emergency. But as it turned out, I was terrified.
‘We need access now,’ the registrar barked. ‘Take all the bloods, including a group and save – he’ll be going to theatre.’
The patient let out a groan, and promptly vomited over his pillow.
Panic rising, I gathered my equipment and trembling, fastened the tourniquet around his bicep. But by now the patient was beginning to writhe and groan louder, intermittently flailing his arms, and then vomiting – this time over the registrar’s arm.
She cursed under her breath, and left the cubicle, wrenching the curtain angrily to one side.
I tried to restrain the patient’s jerking limb, and searched desperately for a glimmer of blue. I could do with spotting the houseman’s friendship now. My clammy hands tapped and slapped, but found no reward. In desperation, I plunged in at a bulging length in the antecubital fossa, but the resulting yelp and thrashing arms confirmed my suspicion that this was no vein. And then I felt the sharp thrust of the needle piercing my own finger, and my heart sank. A needlestick – that was all I needed now.
I turned aghast, holding the offending bloodied finger in the air as the registrar returned. She took one look at me.
‘Get out - you’re no help here.’
I scuttled away to the nursing station, but the response there was no warmer. The nurse grimaced at me.
‘You’ll be needing this,’ she announced, slapping a huge incident book onto the counter, covered with tick boxes, short answer forms and multiple-choice questions. Apparently, my assessments for starting work in the world of medicine weren’t yet over after all.
Susanna Mills now an ST1 in public health in Newcastle-upon-Tyne. At the time of the incident, she was a final-year medical student
This is a great blog. I'm a consultant virologist. I'd like to include this account as part of material for teaching medical students on needlesticks, how they happen and what to do about them. I will not make any personal gain from this, simply use it as part of the teaching curriculum. Is the above material copyright? What attributions are required?
Hi - that's good to hear - thanks! Please could you email firstname.lastname@example.org and we can let you know about using the blog for teaching purposes asap.
The attitude from the E.D. registrar is disappointing, but perhaps can be understood given the stress of the situation. However, the lack of support/ empathy from the nurse in question (away from the acutely stressful situation) is appalling. Sadly, this is a situation that I can envisage happening to others too.
There are two learning points:
1) Never put yourself in danger: if a patient is thrashing or unco-operative for whatever reason, then do not partake in a procedure that has the potential for self-injury;
2) If out of your depth, and particularly as a junior, then seek help. This is for your safety, the patient's safety, for the sake of fostering a good working-environment, et.c..
Always assume anything involving a needle has
the potential for a needle stick injury.So be prepared in all situations of this possible outcome.
I guess there's always an easier way ...
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