Priority Topic: Lacerations

Key Feature 7a: In treating a patient with a laceration: Ask about immunization status for tetanus. 
Skill: Clinical Reasoning
Phase: History

Key Feature 7b: In treating a patient with a laceration: Immunize the patient appropriately. 
Skill: Clinical Reasoning
Phase: Treatment

In any patient with a significant skin wound (ex: laceration, puncture wound such as from a bite or needle stick, crush injury, or others such as avulsions or abrasions) it is important to confirm tetanus status. All patients who receive their routine childhood immunizations will have received tetanus immunisation (DTaP), often with the last routine dose in grade 9 (Tdap). So all children will be covered if they've received all of the routine vaccinations, period. Tetanus immunization lasts up to 10 years, so it is recommended that a tetanus vaccine (Td) be readministered every 10 years. 

UpToDate provides a table advising what to do if a patient presents with a clean or possibly contaminated dermal injury, depending on whether or not the patient has been fully immunised against tetanus and when the most recent vaccination was. The first 3 doses are given as part of the routine childhood series at 2, 4, and 6 months of age. At least that is how it happens in Canada. If administration of the tetanus immune globulin is indicated, this basically provides passive immunity (the immunoglobulins that the body would make that defend against tetanus are instead just immediately delivered - this provides immediate protection, but it doesn't provide long-term protection as these get broken down and eliminated by the body with a half-life of 23 days).