Search
puncture wound
History:
- circumstances surrounding puncture wound Physicial examination:
- neurologic examination to assess damage to peripheral nerve or spinal cord (dependent upon location)
Radiology:
- plain films to rule out retained foreign body
- note wood splinters will not show up on X-ray
- ultrasound may identify wood splinters & other radiolucent retained foreign bodies
Complications:
- infection
- cellulitis & other soft tissue infections
- osteomyelitis
- neurologic injury
Management:
- tetanus immunization as needed (dT)
- if dirty, contaminated wound, add tetanus immune globulin*
- if unknown immunization history, TdAP + tetanus immune globulin
- antibiotics if bacterial contamination not removed with wound care likely
* do not administer IV or in same syringe as tetanus toxoid
Related
puncture
Specific
needle stick
General
wound
References
- Glatter R
5 Diagnostic Errors to Avoid: The Patient With Urgent Symptoms
or Injuries.
Medscape. April 25, 2018
http://www.medscape.com/features/slideshow/diagnostic-errors/emergency-medicine
- NEJM Knowledge+
- Rhinesmith E, Fu L.
Tetanus Disease, Treatment, Management.
Pediatr Rev. 2018 Aug;39(8):430-432.
PMID: 30068747
- Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H.
Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines:
Updated Recommendations of the Advisory Committee on Immunization Practices
- United States, 2019.
MMWR Morb Mortal Wkly Rep. 2020 Jan 24;69(3):77-83.
PMID: 31971933 PMCID: PMC7367039 Free PMC article.