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Tetanus Prophylaxis

- Discussion:
    - goal is to avoid a life threatening clostridium infection;
    - tetanus prone wounds:
           - greater than 8-24 hrs from injury to treatment
           - barnyard contamination (bite wounds are considered moderate risk);
           - devitalized tissue;
    - prophylaxis:
           - if pt is fully immunized in past but has not received booster for over 5 years, then should receive 0.5 ml of tetanus toxoid IM;
           - pts who have not received full course of immunization should not only receive tetanus toxoid but also should receive passive immunization;
           - consider 250 units of human tetanus immune globin IM;
           - peds: 4 units/kg body wt;
    - treatment of tetanus:
           - appropriate antibiotics and debridement;
           - tetanus immunoglobin:
                  - 500-1000 units to a total dosage of 6000 to 10,000 units is given in second arm

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