Question 6
What specific measures would you take to prevent tetanus after wound debridement?
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Answer
This depends on the patient’s immunization status.

If the patient has had two previous injections of tetanus toxoid, one within the last 5 years then he is adequately protected.

In a small, non-contaminated wound no further prophylaxis is necessary.

In a high risk wound, such as a burn, deep puncture wound, crush injury, injuries in thigh, buttock or axilla then the patient should be given a booster dose of toxoid and anti-tetanus immunoglobulin, as well as a mega-unit (600mg) of benzylpenicillin.

If there is inadequate tetanus toxoid immunization:

In a low risk wound one dose of toxoid is enough (with follow-up arranged for booster doses at 1 month and 6 months).

In a high risk wound (or if you are unsure) give him tetanus toxoid and a mega-unit of penicillin and anti-tetanus immunoglobulin.  Continue the penicillin for 5 days or until his wound has healed.

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