Pediatric emergency medicine trisk 3370 3370

TABLE 110.1
TETANUS PROPHYLAXIS
Prior tetanus
toxoid
immunization
(doses)

Clean minor wound

Uncertain (or less Tetanus toxoid–containing
than 3)
vaccine a
Three or more
Td
(most recent
more than 10 yrs
ago)
Three or more
None
(most recent
between 5 and
10 yrs)

All other wounds

Tetanus toxoid–containing
vaccine and TIG or TAT
Td

Td

a If

the child is <7 yrs, give DTap. If the child is 7–11 yrs and is underimmunized, give Tdap. If the child has
already had a dose of Tdap between 7 and 11 yrs, revaccination is not required at 11 yrs.
TIG, tetanus immunoglobulin (dose: 250–500 units IM); TAT, tetanus antitoxin—should be used only if TIG
is not available and after testing (dose: 3,000–5,000 units intramuscularly); Td, adult formulation of
diphtheria, tetanus toxoid.

The emergency provider should consider the location of the wound. If the
wound is in the neck area, there may be possible extension through the platysma
muscle, with potential for a serious injury to underlying structures. If the wound
involves the chest, the clinician should feel for crepitus in the subcutaneous
tissue, suggesting injury to the underlying lung. An injury to the lower extremities
is more likely to result in infection because of the relatively poor blood supply.
Likewise, a wound overlying a joint space can be complicated if the joint cavity
is violated. Injury to distal body parts such as the ears, nose, and fingers may
threaten the viability of more distal tissues secondary to vascular compromise.
Conversely, in areas where the vascular supply is robust, such as the face, scalp,
and tongue, the infection rate is low regardless of the mechanism of injury.
Assess the environment in which the injury occurred. If the injury occurred on
the street, it is possible that small particulate matter may be embedded in the
wound. If this debris is left in place, tattooing of the skin could result, leaving an