Dose of Tetanus Immune Globulin (TIG) - ANSWER-250 units IM
How many doses of Tdap or Td IM needed for protection after clean minor
wounds. - ANSWER-Three doses needed. If <3, unknown, or >10 years since last
dose give dose of Tdap or Td for clean minor wounds. No need to give TIG.
Non-"clean" minor wounds given both of these if unknown tetanus hx or <3 doses
of Tdap/Td. - ANSWER-Tdap or Td IM & TIG
Dirty wounds (puncture, crush injury, soil, saliva, feces, dirt, avulsions, missiles,
burns, frostbite) - ANSWER-If <3 doses Tdap or Td give both Tdap and TIG 250
units. If 3 doses in past, but none in the last 5 years then given Tdap or Td. No
need to give TIG If 3 or > doses in the past
When to switch from DTap to Tdap in children - ANSWER-Age 7 or > given Tdap
A woman becomes pregnant and received Tdap during her last pregnancy 1 year
ago. When should she receive her next dose. - ANSWER-Tdap is recommended
for each pregnancy.
"Getting Tdap between 27 through 36 weeks of pregnancy is 78% more effective at
preventing whooping cough in babies younger than 2 months old (CDC)".
A person with a hx of anaphylaxis to neomycin should avoid which immunizations
(IZ)? - ANSWER-IPV, MMR, varicella
,A person with a hx of anaphylaxis to neomycin should avoid which immunizations
(IZ)? - ANSWER-IPV, vaccinia (smallpox)
A person with a hx of anaphylaxis to bakers yeast should avoid which
immunizations (IZ)? - ANSWER-Hepatitis B
A person with a hx of anaphylaxis to gelatin should avoid which immunizations
(IZ)? - ANSWER-varicella zoster (zostavax) and MMR
Epinephrine needs to be on hand for potential anaphylaxis r/t immunization rxn.
What other interventions/meds should be considered during anaphylaxis? -
ANSWER-Supine, 911, give epinephrine:
7.5-15kg: give 0.1 mg IM x1
15 to <30 kg: give 0.15mg IM; may repeat in 5-15 min x1
>30 kg or Adult: Epipen 0.3mg/0.3mL IM; may repeat in 5-15 min
H1/H2 blocker po (diphenhydramine, ranitidine)
IV access for fluids, Oxygen.
Anticipate ED might give glucagon (if on beta blocker), systemic corticosteroids,
bronchodilators
Which type of vaccine boosts immune response better? conjugate vs.
polysaccharide - ANSWER-conjugate (example: prevnar)
Live attenuated (weaned) vaccines - ANSWER-MMR, Varicella and intranasal
Flu-mist. Zostavax is also live. Shingrix is NOT live.
When is rotavirus vaccine contraindicated? - ANSWER-SCID (severe combined
immunodeficiency) or hx intussusception
Precautions after rotavirus - ANSWER-hand washing!; viral shed in stool in first
week post-vaccination
Shingrix: timing and dosing - ANSWER-=/> 50 y/o, 2 doses, 2nd dose two to six
months after 1st dose.
Under age 50 y/o gets shingles; think immunocompromise vs. stress.
What month does the CDC release a new vaccination schedule each year? -
ANSWER-Feb
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