Step 2

Pathology

An 11-year-old boy presents to the emergency department with his parents 1 hour after stepping on a rusty nail with his bare foot. He received his 5th dose of DTaP vaccine at age five and has not yet received his first dose of Tdap. He is otherwise up to date on his vaccinations and has no chronic conditions. His vital signs are notable for mild tachycardia, and physical examination is notable for a 0.5 centimeter punctate lesion on his right heel that is oozing blood. There is significant dirt in and around the wound.

In addition to wound irrigation, which of the following is the next best step in management?

  • A) Administer a tetanus toxoid-containing vaccine
  • B) Administer a tetanus toxoid-containing vaccine and human tetanus immune globulin
  • C) Administer human tetanus immune globulin
  • D) No additional action
  • E) Prescribe levofloxacin

Authors

Alexandra Conway

Editor

Dr. Ted O'Connell

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