PREVENT Care 32 - sami2004

[ArchivalUser]

A 13-year-old boy is brought into the emergency
room with a laceration of his right arm. According
to his parents, he received the injury when he fell on
the ground while playing at the family farm about
1 hour ago. He has no known history of any medical
problems. His parents say that they haven’t brought
him to the doctor in years. On questioning, they
report that he only received one of his “baby shots”
and they are not sure which one that was. On examination,
he is healthy appearing. He is appropriately
apprehensive but calm and consolable. His right
arm has a 5 cm linear laceration with visible soil
particles in and about the wound. The remainder of
his examination is unremarkable. You carefully
clean and irrigate the wound and then primarily
repair the laceration with sutures.

What immediate tetanus prophylaxis would
be optimal in this case?
(A) IM injection of adult Td vaccine only
(B) IM injection of both adult Td vaccine
and tetanus immune globulin (TIG)
© IM injection of Tdap only
(D) IM injection of TIG only
(E) IM injection of both Tdap and TIG

[ArchivalUser]

B) IM injection of both adult Td vaccine
and tetanus immune globulin (TIG)

[ArchivalUser]

bb

[ArchivalUser]

sorry i want to choose ee

[ArchivalUser]

BB

[ArchivalUser]

e...

[ArchivalUser]

ee

[ArchivalUser]

B
Hate pediatrics!

[ArchivalUser]

whats the ans sami?

[ArchivalUser]

ANSWER IS E

The disease tetanus is caused by an exotoxin
produced by the anaerobic, gram-positive bacterium
C. tetani. The spores of C. tetani are
endemic in soil, particularly in agricultural
areas. They can also be found in the intestines
and feces of many animals. Human infection
usually is the result of the introduction of the
spores through a wound, such as a puncture or
laceration. The spores can then germinate and
toxins are released. Tetanus is characterized by
unopposed muscle contractions and spasms.
Autonomic nervous system manifestations,
seizures, and difficulty swallowing may occur.
Recovery may take months, but the disease is
often fatal. In the developed world, most cases
of tetanus occur in those who either were
never vaccinated or who completed a primary
vaccine series but have not had a booster in
the preceding 10 years. The currently available
vaccine is a toxoid which consists of a
formaldehyde-treated toxin. It is available as a
single antigen vaccine, combined with diphtheria
(pediatric DT or adult Td) or combined
with both diphtheria and acellular pertussis
vaccine (DTaP). Whenever possible, tetanus
toxoid should be given in combination with
diphtheria toxoid to provide periodic boosting
for both antigens. There is little reason to use
single antigen tetanus toxoid alone.