Posted on 01/06/2024 3:10:16 AM PST by Jemian
My husband and I need some medical advice.
We live in Sentani, Papua, Indonesia. One of the things we do is provide a home for two pre-teens from an even more remote location.
The boys just returned to us from spending Christmas with their family a few hours ago. We have just learned that the youngest, age 11, stepped on a nail a week ago. His family took him to a doctor and was treated. When the boy told us about it tonight at supper and mentioned he may need to have additional care here, he said that the doctor did NOT give him a tetnus shot. We, at this moment, do not know if he has even been vaccinated. We're trying to locate that information.
My question is: have we missed the window of time to get a tetnus shot? If so, what are symptoms of tetnus?
I have looked at the wound and do not see any infection. It is quite tender, but minimal, if any, swelling, no pus or discharge. Sadly, under the skin, there was an area about the size of a quarter that was filled with black sand (or gravel the size of sand). I did minimal cleansing with hydrogen peroxcide and some of the dirt was removed. Now, we're having him soak his foot in warm soapy water with about a handful of epsom salts.
Any advice? We want to help and not harm. We do live in town and can take him to a doctor tomorrow. (It is already late on Saturday night here.)
"Tetanus...is a bacterial infection...characterized by muscle spasms. In the most common type, the spasms begin in the jaw, and then progress to the rest of the body. Each spasm usually lasts for a few minutes. Spasms occur frequently for three to four weeks. Some spasms may be severe enough to fracture bones. Other symptoms of tetanus may include fever, sweating, headache, trouble swallowing, high blood pressure, and a fast heart rate. Onset of symptoms is typically 3 to 21 days following infection. Recovery may take months, but about 10% of cases prove to be fatal.
as a rule of thumb, try to get the tetanus booster shot within 48 hours of the injury
One week down, two to go. There is access here to the medicines mentioned in Wikipedia.
The Hubs and I are totally miffed that the doc in their home town did not irrigate and clean the wound.
So, that window of time has closed. We’re moving on to the watch carefully period.
It sounds like there might be a small abcess beneath the tough skin of the foot. This might have to be drained by a doctor or clinic nurse. Very painful to do without xylocaine.
If he had tetanus vaccine in the past 5 to 8 years it probably will protect him.
Apparently there is something called TIG which acts as a prophylactic; if he has not been vaccinated, it might be worth looking into.
Swedish Health Care recommendations re tetanus prophylaxis in adults with wounds:
Vaccinated against tetanus?
NO: Human immunogolubline + dose 1 of vaccination
YES:
Vaccinated 1 time: Human immunoglobuline + 2nd dose of vaccine, follow up with 3d dose 6 - 12 months later
Vaccinated twice at least 6 months since latest dose: 3d dose of vaccine
3 doses of vaccine, more than 10 years since latest dose: 4th dose of vaccine
At least 4 doses of vaccine but more than 20 years since last dose: give combinations vaccine.
OK, it may be a bit late but suggest that you contact doctor. Depending on the vaccination status of the young lad, treatment as noted above.
I concur, Doctor.
I’ve had very good results with amoxicillin/clavulanate for many decades now in outpatient medicine - specifically for foot puncture wounds with and without shoes (nails going through shoes I’ve used 875mg/125mg once daily for 5 days as prophylaxis, twice daily for 7-10 days for gross contamination, lacerations, etc. Ciprofloxacin is a good alternative, or has been for organisms mentioned including pseudomonads. The Sanford Guide is your friend… I’ve carried a copy since 1987 and I could read it without glasses).
From what the OP described, this does sound like a contaminated wound, not just simple “tattooing” from carbon or plant matter/dye.
Best care is I&D/debride as necessary, antibiotics and a Tetanus toxoid booster at least if not DTaP series for a child.
I’ve seen keflex work on C. tetani infection - patient had a skin “rash” from yard work, NP in my clinic Rx’d keflex and sent out a culture (thank God), turned out to be C. tetani and he had never had a vaccine but the wounds healed without complication.
Thank you. We’ll get him into a clinic tomorrow. A lot of the dirt trapped under the surface layer of skin left with the soaking. We plan to have him soak the foot again tomorrow.
I was looking for a sign of an abscess. But, he did not want me probing too much and I didn’t force the issue. If it were me, I would have suffered through it. But with him, nope, I didn’t even try.
We’re still reviewing our records to find a tetanus vaccination history.
Thank you for your advice. We’re following it and getting him to the clinic tomorrow.
Advice regarding unvaccinated children: Human immunoglobulins regardless of time from injury and appearance of wound. Follow up with vaccinations.
Unless you really can’t afford to take him to a Dr, I wouldn’t just wait & see.
What is “I&D”? Irrigate and debride? That we began tonight and will continue in the morrow. The kid fell asleep before we were finished!
PS, or by the way, I NEVER use hydrogen peroxide on open wounds.
Peroxide does as much tissue damage as it does bacterial action - if any. This leaves devitalized/dead tissue behind as food the remaining bacteria to feast upon.
Despite decades of surgeons, infectious disease and wound care specialists doing their best to prove one agent works better than another for cleansing wounds, what seems to come up a winner - repeatedly, in one study after another - is TAP water (in the US anyway) or just plain fresh water. Boil if you need to knowing that if water comes to a boil, it’s ALL the samme 212F temp and is sufficient to kill most common organisms. Let it cool and use that.
Tap water is chlorinated (which helps), it’s readily available, there’s plenty of it and you can adjust the temperature. Better would be normal saline or pH bufferred, but the general idea is expediency.
But peroxide? In the words of my microbiology professor in med school, “it fizzes and foams and looks like it’s doing somethign but it’s just burning tissue.” Later studies in my career have borne this out.
FWIW.
Money is not the issue, neither for us, nor the boy’s parents. Very probably, the parents didn’t understand the seriousness. He was taken to a local clinic and, frankly, neither my hubs, nor I feel they did a thorough job. They did what any first aid provider would do.
The boys returned to us less than 12 hours ago. We just learned of this. The clinics were closing when the boy told us about his injury. We’re dealing as promptly and as efficiently as possible.
I realize that I don’t always have the latest and greatest information. That is why I asked the questions here. I appreciate all the advice given and will be following it.
“Peroxide does as much tissue damage as it does bacterial action - if any. “
An ER doctor told Hubby that a few weeks ago. We were surprised.
That is news to me as well. I’ve used peroxide since the early 60s. I’ll have to get my brain wrapped around that one.
Get him in to see a doctor.
Good to hear. Good luck
I have used diluted peroxide on my dog’s wounds in the past without problems, but the Vet said never to use it undiluted (very diluted). I would assume it’s the same for people. Instead of peroxide, now I use diluted Betadine antiseptic on the dog wounds and have even put a tiny bit in my Neti Pot for sinus issues. Peroxide is what people used WAY back when nothing else was available and it was cheap. There are better things now.
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