Step 1 — Wound type
Step 2 — Tetanus vaccination history
Reference
Vaccine products
- Tdap (Adacel, Boostrix) — preferred if never received
- Td — use if Tdap given previously or contraindicated
- TIG (HyperTET) — 250 units IM, separate site from vaccine
- If both needed: give at separate sites simultaneously
Tetanus-prone wound features
- Contaminated (soil, saliva, feces)
- Puncture wounds
- Crush injuries or avulsions
- Animal or human bites
- Burns or frostbite
- Missile wounds
- Wounds >6 hours old
- Devitalized / ischemic tissue