Tetanus Prophylaxis
Basics of Tetanus
Tetanus is a bacterial infection caused by Clostridium tetani (anaerobic). It is characterized by muscle spasms. Other symptoms include fever, sweating, headache, dysphagia, hypertension, and tachycardia. The bacteria can be found in the soil, rusted objects, dust, manure and saliva. The bacteria produces toxins which interfere with normal muscle contractions (results trismus, risus sardonicus, opisthotonus. tetany, dyspnea/apnea). The farther the injury site is from the CNS, the longer the incubation period (usually around 10 days to months). The tetanus neurotoxin blocks the release of the neurotransmitters GABA and glycine from inhibitory neurons (results in over activity of muscles). Tetanus is a notifiable condition.
Determinants of Immunization
- Condition of the wound
- The patient’s immunization history
Wound Classification
| Clinical Features | Tetanus Prone Wounds | Non-Tetanus Prone Wounds |
|---|---|---|
| Age of the wound | >6 hours | < 6 hours |
| Configuration | Stellate wounds, avulsion | Linear wound, abrasion |
| Depth of wound | >1cm | <1cm |
| Mechanism of Injury | Missile, Crush, Burn, Frostbite | Sharps (knife, glass) |
| Signs of infection | Present | Absent |
| Devitalized Tissue | Present | Absent |
| Contamination (dirt, feces, grass, saliva etc) | Present | Absent |
| Denervated and/or Ischemic tissue | Present | Absent |
Immunization
| History of Tetanus Toxoid Received by Patient | Is the wound Tetanus-Prone | Is the wound not Tetanus-Prone | ||
|---|---|---|---|---|
| Tetanus Toxoid | Tetanus Immunoglobulins | Tetanus Toxoid | Tetanus Immunoglobulins | |
| Unknown or less than 3 vaccines | Yes | Yes | Yes | No |
| 3 or more vaccines received | No (However, give if >5 years since the last vaccine dose) | No | No (However, give if > 10 years since the last vaccine dose) | No |
Dosages
- Tetanus Toxoid: 0.5ml IM stat
- Tetanus Immunoglobulins: 250 units IM stat (Note: Therapeutic dose is 3000-6000 units)
Notes
- Wounds should receive immediate surgical treatment
- Devialized tissue should be removed
- Foreign bodies/dirt should be removed
- Tetanus-prone wounds should be left open (consider if possible)
- Contraindication to vaccine: Severe hypersensitivity reaction
- Most of the information, especially the tables where adapted from a booklet called “Prophylaxis Against Tetanus in Wound Management” by the American College of Surgeons Committee on Trauma found here.
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