First, classify the wound: Clean wound vs.

Tetanus Prone wound Yahya Firoze

Tetanus Prone wound is any wound or burn that is/has:

- Puncture wound
- Extensive devitalized tissue
- Seen in wound: Soil, Manure (animal feces), Foreign body
- Compound fracture
- Patient has a picture of Sepsis
- Wounds/Burns where >6hrs have passed before surgical intervention

For Tetanus Prone Wound:

Step 1: Give TETANUS IMMUNOGLOBULIN
Step 2: Look at Immunization Status
 Immunization up to date = nothing else needs to be done

 Immunization up to date but now it’s time for their next vaccine dose according to their schedule = give
their Vaccine dose (Tetanus toxoid + IPV = Td/IPV)

 Immunization NOT up to date = give Vaccine (Td/IPV)

 Immunization status not known = give Vaccine (Td/IPV)
 Immunosuppressed (ex: HIV) = give Vaccine (Td/IPV)

Clean Wound:
Step 1: DO NOT give Tetanus Immunoglobulins
Step 2: Look at Immunization Status
 Immunization COMPLETE (i.e. all 5 doses done) = nothing else needs to be done

 Immunization up to date but now it’s time for their next dose = give Vaccine
 Immunization NOT up to date = give Vaccine
 Immunization status not known = give Vaccine
 Immunosuppressed = give Vaccine

What is a normal immunization schedule for Tetanus Vaccination?

- Total of 5 doses [2mo, 3mo, 4mo, 4yrs, after 10yrs have passed (i.e. 14yrs old)]
o This differs slightly in older individuals (see further below)
- The first three of these doses are known as the Primary doses
- The fourth dose is called the First Booster dose
[in ppl aged <10yrs, this dose should be at least 3yrs after previous one]
[in ppl aged >10yrs, this dose should be at least 5yrs after the previous one]
- The fifth dose is called the Second Booster dose

So, if you are following a new born baby, you will give doses in these ages:
- Age: 2months, 3mo, 4mo, 4yrs, 14yrs
- If a kid (<10yrs) who has never been vaccinated, you will follow this format as well, except the first dose you will give
now becomes like the 2mo dose and so forth…

So, if a 23 yr old man comes to you who has never been vaccinated, you will give doses like this:
- Age: The day he comes to you, 1mo after that, 1mo after that, 5yrs after that, 10yrs after that
- 1st – Jan 2000 (day he came)
- 2nd – Feb 2000
- 3rd – Mar 2000
- 4th – Mar 2005 [this dose should be at least 5yrs after previous]
th
- 5 – March 2015