Should I have let them do a tetanus vax?

[momtoafireteam]

Today my 2 year old (totally unvaxed) fell at the park and cut her chin open. It was a very clean, neat, flat laceration about ----- that long. When pulled apart it was quite deep, but it wasnt gaping. I took her to the ER because I could see white fat in the bottom of the wound and I know that means a Doc visit!! lol.

Dr says its not bad enough for stitches but we do do the dermabond stuff. He obviously askes if she is vaxxed and when I say no he gets very upset and tells me we will do tetanus.

While the nurse is getting it ready I realize I REALLY don't feel comfortable doing that and I deny it. The Doc comes back and he is pissed. He says I can deny it, but that do I understand how serious tetanus is and that she will die and do I fully understand what I am doing....

Then, upon discharge, instead of discussing with me the care of the flipping wound we are there for, he seriously spends 10 minutes telling me what to look for for tetanus. And how she can die (again) and how serious tetanus is (again) and how the US is relatively tetanus free because of vaccinations. Again.

I left feeling like crap. Should I go on Monday and do the tetanus? Can anyone give me any input here?

Oh, in case it matters the park was plastic and she never touched dirt or anything.

[peainthepod]

The wound bled copiously, right? And you could see the bottom, meaning it was entirely exposed to air? And your baby doesn't have any circulatory problems that you know of?

Not a tetanus risk IMO. Your doctor might have been genuinely concerned, but it was still scaremongering. I wouldn't worry one bit. Hope your LO feels better soon and I'm sorry the doctor treated you that way.

[Momalea]

I wouldn't have done tetanus shot either (my kids are totally unvaxed). From what I've read in your post and what I've read about what tetanus needs to thrive, it doesn't sound necessary in your dd's situation. Sorry you were hassled-I dread the first time we have to face this.

[pantufla]

The tetanus vaccine won't do you any good after the fact. It takes several weeks to build up the immunity required. If the doc were truly concerned s/he would have offered the tetanus immune globulin.

Remember, vaccines are not emergency medicine.

[rmzbm]

There was no reason to get it. None. You did the right thing, good job staying strong in the face of all that! I am so sorry you were treated that way.

[Emmeline II]

Ugh, I would write a letter to the hospital about the rude manner of the Dr and how he failed to instruct you on caring for your son's injury because he was too busy trying to convince you that your ds would be one child, of the millions of children in the US, that get Tetanus each year.

In the United States, tetanus is primarily a disease of older adults. Persons greater than or equal to 50 years of age now account for over 70% of reported cases. An average of 43 people per year contract Tetanus and there are 0-2 deaths out of a population of 301,139,947 (over 300 MILLION) in the US. (In comparison (FEMA) estimates there are 200 deaths and 750 severe injuries from lightning each year in the U.S.). A Tetanus vax at time of injury is supposed to be a booster to those current on vax and TIG (tetanus immunoglobulin) is for the unvaxed.

From 1992 through 2000 (9 years), 15 cases of tetanus in children <15 years of age were reported from 11 states. Two cases were in neonates <10 days of age;the other 13 cases were in children who ranged in age from 3to 14 years. The median length of hospitalization was 28 days; 8 children required mechanical ventilation. There were no deaths. (I don't have info on their state of health or wound care).

It is not the rust that causes tetanus, so a rusty nail in and of itself is not the issue. Tetanus needs an anaerobic environment to thrive. A wound that has bled is not typically that environment. Keep it clean and covered.

"Keep in mind that the tetanus vaccine became available for widespread civilian use in the late 1940's. Thus tetanus mortality had declined from 205 deaths per 100,000 wounds in the American Civil War (1860) to about .4 deaths per 100,000 population in 1947 at the beginning of widespread civilian use of the vaccine. This means that sanitation, nutrition, year around nutritional improvements, general hygiene, and wound hygiene had reduced the mortality and incidence of tetanus by as much as 99.8 percent before the widespread use of tetanus vaccine." Hilary Butler 89wds


Clostridium tetani: the bacterial species that causes tetanus; it produces a potent exotoxin (neurotoxin) that is intensely toxic for humans horses, and other animals when formed in tissues or injected, but not when ingested. The organism is found in soil, especially heavily-manured soils, and in the intestinal tracts and feces of various animals. Carrier rates in humans vary from 0 to 25%

Tetanus as a clinical entity is linked to a bacteria, Clostridium tetani. Obviously, the germ is not as malicious as one may think because it lives as a harmless commensal in the animal and human intestinal tract (1). It is not the very presence of the bacteria which causes the trouble, but the toxins that are produced by the bacteria under anaerobic conditions, that is, where the bacteria operates in an environment free of oxygen. These toxins can be spread through the blood vessels and finally affect the nervous system causing tetanic muscle contraction and pain.


Caring for a puncture wound
Several times a day for four or five days, soak the wound in warm water. Use a bathtub or basin if the wound is on the foot or leg. Soaking helps clean the wound from the inside out.

Monitor carefully for signs of infection. Because puncture wounds go deep, an infection may not become visible for several days after the injury.

When to seek immediate medical help
When the wound becomes infected. Signs of infection include pus, increased pain, swelling, redness, tenderness, a sensation of warmth or visible redness radiating from the wound, or a fever of 100 degrees F or more.

http://iier.isciii.es/mmwr/preview/m...l/00000940.htm

Treatment of Tetanus



Immune globulin, given intramuscularly, is the immediate treatment of unimmunized individuals exposed to material likely to contain the tetanus bacteria. Treatment includes bed rest and quiet conditions. Immune globulin (also called gamma globulin or immune serum globulin) is a substance made from human blood plasma. The plasma, processed from donated human blood, contains antibodies that protect the body against diseases. When you are given an immune globulin, your body uses antibodies from other people's blood plasma to help prevent illness.

Sedation, paralysis with certain medications, and mechanical ventilation (i.e., respirator) may be necessary to control the spasms.
Antimicrobial drugs, such as penicillin, are used to eradicate the bacteria.


Recovery
For patients who survive tetanus, recovery can be long (1 to 2 months) and burdensome. Muscle spasms may begin to decrease after 10 to 14 days and disappear after another week or so. Residual weakness, stiffness, and other complaints may persist for a prolonged period, but complete recovery can occur from uncomplicated tetanus.
Patients with tetanus are hospitalized in an intensive care unit until it is clear that the progression of the disease has stabilized at a level that does not interfere with vital functions, and that therapy can be managed outside the unit.


There are four forms of tetanus immunization.
http://www.nlm.nih.gov/medlineplus/e...cle/002031.htm
The DTaP vaccine is a "3-in-1" vaccine that protects against diphtheria, pertussis, and tetanus. It can be given to children less than 7 years old. It is injected, usually into the arm or the thigh. DTaP is a safer version of an older vaccine known as DTP, which is no longer used in the United States.
The DT vaccine is a "2-in-1" vaccine that can be given to children less than 7 years old. It does not contain pertussis vaccine, but does contain vaccine that protects against diphtheria and tetanus. It is injected, usually into the arm or thigh.
The Td vaccine is the "adult" vaccine. It is a "2-in-1" vaccine that protects against tetanus and diphtheria. It contains a slightly different dose of diphtheria vaccine than the DT vaccine. It can be given to anyone older than 7 years old. It is injected, usually into the arm.
A booster Td vaccine should be given at ages 11-12. Older children who need a booster Td vaccine at ages 11 or 12 should receive the tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine. Older children between age 11 and 18 who have not already recieved a TD booster vaccine should receive the new Tdap vaccine.
Instead of the standard Td booster every 10 years, adults between the ages of 19 and 65 should receive Tdap one time.
Tetanus vaccine (T vaccine) can be given as a single vaccine, but this is not generally available. It is also injected, usually into the arm.
Tetanus immune globulin is not actually a vaccine. It is a preparation that is made from serum (part of the blood) from a person or animal (such as a horse) that contains antibodies against tetanus.

[momtoafireteam]

Thank you so much everyone.

Oh, it bled copiously!! Whole outfits have been ruined! This morning I feel much better about the decision. Thanks again!!

[mammal_mama]

Originally Posted by momtoafireteam

Thank you so much everyone.

Oh, it bled copiously!! Whole outfits have been ruined! This morning I feel much better about the decision. Thanks again!!

I'm so glad you didn't do it! Tetanus only grows in the absence of oxygen. I was a little scared when my 8yo got a long splinter that went straight into her finger last summer (no bleeding), so that only the tip was showing. I was looking online into ways of dealing with the splinter -- but dd begged to be taken to the ER, she said she knew professionals could deal with it painlessly.

Well, she learned it wasn't so painless -- but they questioned dh about whether her tetanus was up-to-date (he took her in because our 3yo was sleepy) ... dh just said, "How common is tetanus these days?" -- and they totally dropped the issue!

I'd felt concerned about the tetanus possibility, because of no bleeding, and she'd got the splinter jumping onto our deck, which likely could have had dirt on it. But I just took the doctors' advice to soak her finger -- I think it was 2x a day for 3 days -- to lower the risk for infection. And she did fine.

[chaoticzenmom]

I think you did great! You trusted your instincts in the face of an accident and a pushy dr. Good for you!

[Momalea]

Thanks for such a comprehensive reply Emmeline II! I actually printed it out as a reminder of why we don't need a tetanus vaccine shot at the ER.

[columbusmomma]

Originally Posted by Momalea

Thanks for such a comprehensive reply Emmeline II! I actually printed it out as a reminder of why we don't need a tetanus vaccine shot at the ER.

YES! Thank-you

[milkybean]

Originally Posted by mammal_mama

... but dd begged to be taken to the ER, she said she knew professionals could deal with it painlessly.

Well, she learned it wasn't so painless -- ...

Oh poor kiddo. I once got a nasty nasty sick and wrong splinter (while watering the garden, while naked, LOL, at 4'ish) and was taken to the ER. I can still remember the very very painful shots all around my toe, in between the toes, to make it pain-free for them to take out the wood and clean it! OUCH OUCH OUCH! Between the toe shots are probably just as bad as them just pulling it out.

[CookAMH]

Originally Posted by momtoafireteam

Should I go on Monday and do the tetanus? Can anyone give me any input here?

NOOOOOOOOOOOO. She is absolutely not at risk for tetanus with that injury. Period.