Jun 29, 2009 11:08 am US/Eastern
Dr. Mallika's Files: The Rusty Nail
Each week Dr. Mallika Marshall shares cases based on true stories from a local urgent care clinic, exclusively on wbztv.com. Names and identifiable characteristics of patients have been omitted or changed to protect patient privacy.
This Week's Case:
A 32-year-old man comes to the clinic saying that earlier that day he was fixing an air conditioning unit down in his basement when his left hand slipped and got punctured by a "rusty" nail.
The nail did not go through his hand and the small puncture wound bled for only a few seconds. He applied hydrogen peroxide and wrapped his hand in a dish rag. He does not remember when he received his last tetanus shot.
He always heard that if you get injured with a rusty nail you should seek medical attention right away.
On exam, the patient is well-appearing with normal vital signs and a small pinpoint entry wound on the palm of his left hand. There is no bleeding, no redness and minimal tenderness at the site of the injury.
Discussion:
One complication we worry about when a patient has an open wound is tetanus, sometimes referred to as "lockjaw."
Tetanus is caused by infection with a bacterial spore found in soil. The spores can enter the body through a cut or scratch or any open area on the skin. Those spores then release bacteria that spread and produce a poison that causes severe muscle spasms.
Tetanus often begins in the jaw muscles but can then affect muscles all over the body including the muscles required to breathe.
Tetanus can be prevented with a tetanus vaccine which children receive as part of their routine immunizations and adults should get every ten years.
Open wounds can also become infected with more common bacteria which, if not treated promptly, could spread to surrounding tissues, neighboring bone, or the bloodstream.
If you have an open wound, clean it thoroughly with soap and water, apply a topical antibiotic ointment, and cover it with a sterile dressing or bandage.
If a wound is large, won't stop bleeding, or may need suturing, you should seek medical attention immediately.
All animal and human bites should be evaluated as well. And if you haven't had a tetanus booster in over 5 years, you should get one right away.
Follow-up:
The patient's wound was cleaned with surgical soap and water and he was given a tetanus vaccine.
He was told to return at the first sign of infection such as redness, increasing pain, drainage, or fever.
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