DIP Episode 615 - Easy Understanding of The Tetanus Vaccine + Vaccine Test Taking Strategies

All right, welcome to episode 615 of the Divine Intervention Podcast. My name is Divine. Today we're going to be going over a very short topic. In fact, this is probably going to be one of my shortest podcasts. But this topic is something that is just a pain for many people to memorize. So I'm going to give you an easy way to remember it. So we're going to be talking about the easy way to memorize the tetanus vaccine. And then I might say a few things at the end and then we'll wrap this up. Now, what are the critical, like if you basically know the spot cast, you're set with tetanus. So first things first, what are the different kinds of vaccines for tetanus? Well, there's the D-top vaccine. There's the T-dop vaccine and there's the T-d vaccine. Okay. There's D-top. There's T-dop. There's D-top. There's T-dop and then there's T-d. If you notice D comes earlier than T in the alphabet. Shota should help you remember that D-top is giving only two kids. The D-top vaccine, the D-theria, tetanus and A-cellular pertosis vaccines are giving only two kids. All right. Now, T-dop is the next one. Right? T-dop can be given to Adoli Sens and Adol. Basically, I present that as not a kid. And then T-d, the T-d vaccine is giving only two adults, only two adults. Now, one thing I have noticed that really scruples people up with the tetanus vaccine is that they try to merge so many things together instead of being systematic and organizing slash categorizing things.

And honestly, the method I'm about to go over, I feel like, is the best method to categorize things. So, what are the two dichotomies you need to keep in mind with the tetanus business? You need to know when you should give the tetanus vaccine and then you need to know when you should give the tetanus immune globally. Do not merge those decisions together. Separate them and you being good shape. So let's start with the one that is actually more difficult. When do you give the tetanus vaccine? Literally, when do you give the tetanus vaccine? Okay. Now, to know when to give the tetanus vaccine, the first rule you need to learn, I'm going to teach you basically four rules. If you know these four rules, you're set for when to give the tetanus vaccine. Rule number one. Rule number one. Rule number one. You should never give the vaccine regardless of the kind of wound if you meet two criteria. Number one, you've completed the vaccine series. Number two, it's been less than five years since you took the vaccine. If it's been less than five years since you took the vaccine and you've completed the vaccine series, you don't give the tetanus vaccine regardless of the kind of wound. Be clean, be dirty, doesn't matter. All right. That's rule number one. What's rule number two? Rule number two is that you all have a lot of things to do with the tetanus vaccine. That's rule number one. What's rule number two?

Rule number two is that you always need the vaccine regardless of the wound if you fall into certain categories. So these are the people that always need the vaccine. Doesn't matter what the wound is, be clean or dirty. If they're on vaccine needed, which makes sense, right? If you've not got in the vaccine, doesn't matter what wound you get, you should get that vaccination, right? Or if we don't know your vaccine history, if your vaccine history is unknown, or you've not completed the series, the vaccine series, right? So basically, if you have a wonky vaccination history, either you've not been vaccinated, we don't know your vaccine history, you've not completed the series. It literally does not matter what kind of wound you have, you will, you should always get the tetanus vaccine. All right. So notice we've considered the two extremes. First extreme was rule number one. Or regardless of the wound, never get the vaccine. If you've completed the series, it's been less than five years since you got the shot, right? Now, the other extreme was, hey, regardless of the wound, you should always get the vaccine. If again, you have a wonky vaccine history, never been vaccinated, or the vaccine series is not complete, or your vaccination status is unknown. All right. Now, let's look at the middle ground situation, right? And this middle ground situation is, you know, when, you know, you know, it's like, oh, your clean ones, when do you do this versus this?

For dirty ones, when do you do this versus that, right? See, if you want to know the right thing to do, all you need to do is to assess two pieces of information. If you want to know the right thing to do, all you need to do is literally assess two pieces of information. Number one, have you completed the vaccine series? Number two, is it five or ten years since you got the vaccine? Number one, have you completed the vaccine series? Number two. Is it five or ten years since you got the vaccine? So here's the thing. Here's the thing. Here's the thing. If you have a clean wound, if you have a clean wound, you should only get the vaccine if it's more than ten years since you got the vaccine, if you have completed the series. If it's more than ten years since you got the vaccine, and you've completed your vaccine series for a clean wound, get the vaccine, get the vaccine, right? Now, how about for a dirty wound? We know that a dirty wound is higher risk. Since a dirty wound is higher risk, obviously, the criteria have to be more restrictive, right? So if you have completed the series, but it's more than five years since you got the vaccine, it's more than five years since you got the vaccine for a dirty wound, then you should get the vaccine. You should get the vaccine. All right. Again, I'm just trying to show you logically why these rules work. Okay. So again, let's do the four rules. The four rules for the vaccine.

Remember I said separate the vaccine from the immune globally. The vaccine part is the hard part. The immune globally part is super easy, super, super easy. Okay. So let's talk about the vaccine. Again, row number one, it does not matter what kind of wound it is. If it's been less than five years since you got the vaccine, you've completed your vaccine series. You don't need any kind of vaccine in that circumstance. Row number two, the other extreme. It doesn't matter what the wound is. It doesn't matter what the wound is. If you have a wonky vaccine history, what do I mean by a wonky vaccine history? You did not complete the vaccine series, right? We don't know your vaccination status or you've been unvaccinated. It doesn't matter what the wound is, you always get the vaccine. And then for rows three and four, I said that hey, if you've completed, if I wrote three and four, I like to call it the, if you've completed the vaccine series rows, if you've completed the vaccine series rows for rows three and four, basically, it's like, hmm, for a person that has completed the vaccine series, where should they still get the vaccine? If you understand row number one, rows number three and four are like a natural outgrowth of that role. But basically, if you have a clean wound and you've completed the vaccine series, we only give you the vaccine again. If it's been more than 10 years since you got your vaccine, if it's been more than 10 years, okay?

Row number four, if you've completed the vaccine series and you have a dirty wound, then we only give you the vaccine again. If it's been more than five years since you got the vaccine and again, that should make sense. A dirty wound is a higher risk wound. So we're not going to give you that 10 year time gap. We're going to do only five years. That's it. All right. Next thing we're going to go to now is the immune globular. Is the immune globular. The immune globular, right? Again, remember the tetanus vaccine that's giving, getting active immunities different from the immune globular, which is passive immunity. All right. So the immune globular, very simple. There's literally just one dichotomy to follow. Is it a clean wound or is it a dirty wound? That's it. Is it a clean wound or is it a dirty wound? If it's a clean wound, you never get the immune globular. Tetanus immune globular is never given for clean wounds. The end. But how dirty wounds? How about dirty wounds? How about dirty wounds? How about dirty wounds? See, for dirty wounds, you're going to give the tetanus immune globular. If you fall into one of two categories of people, I'm going to say that again. For dirty wounds, we're going to give you the tetanus immune globular. If you fall into one of two categories of people, who are the two categories? One, if you have a wonky vaccine history, and you know the people that fall into that wonky vaccine history based on what I've said already.

And then, two are the people that are immunocompromised, right? So like the wonky vaccine history, people that are on vaccinated, right? People that their vaccine history is unknown. People that never completed the series. If it's a dirty wound, they should always get the tetanus immune globular. Now, why immunocompromised people is going to make sense? You have HIV, for example, or you have an immunodeficiency disease. And for those people, if they have a dirty wound, they should always get the tetanus immune globular. That's it. Fini. That's it. That's it, right? So again, just to really get this into your heads, let's summarize one more time. The tetanus vaccine, there are four rules, right? There are the two extremes and then rules three and so the two extremes, connotals, one and two, rose three and four are for the people that have completed the series, right? This is the vaccine we're talking about now for the vaccine. What's row number one extreme number one? You don't give the vaccine regardless of the wound type. If you meet two criteria, you got to meet both. You've completed the series and it's been less than five years. Since you got your vaccine. Extreme number two is row number two, right? It doesn't matter what the wound is, you will always get the vaccine if you have a wonky vaccine history. Who are the people with a wonky vaccine history? People that never completed the vaccine series.

People that are on vaccine needed or people whose vaccination status is unknown, right? And then rose three and four, I said, these are the, these rules only apply to people that have completed the vaccine series. If you have a, row three, if you have a clean wound and you've completed the vaccine series, we're only going to give you the vaccine. If it's been more than 10 years since you got your vaccine last. Row number four, if you've completed the vaccine series, and it's a dirty wound, right? It's a dirty wound. We're only going to give you the vaccine. If it's been more than five years since you last got the vaccine. Remember, for people that have a dirty wound, it's a higher risk. So we're going to use more restrictive criteria, right? So row three, you've completed your series, you have a clean wound, we're only going to give you the vaccine. If it's more than 10 years since you got your shot. Row four, if you've completed the series and it's a dirty wound, we're only going to give you a vaccine. If it's more than five years since you got your shot, that's it. I promise you guys, this is very easy to memorize and this is the best way to memorize this thing. And then let's look at the immune globulin, much simpler, much simpler. All you need to assess is, hey, is it a clean wound or dirty wound? If it's a clean wound, you never give the immune globulin. It doesn't matter who you are. If it's a clean wound, you never give the immune globulin.

But if it's a dirty wound, if it's a dirty wound, you're going to get the immune globulin. If you're one of two groups of people, you have a wonky vaccine history. We know the wonky vaccine history people, right? Unvaccinated vaccine history unknown, have not completed the vaccine series. Or if you're immunocompromised, HIV, you have any middle deficiency disease. That's it. That's it. Right? And then some other things to kind of know about the, the, the, the tetanus vaccine is, um, remember, if you're pregnant, you're going to get the tetanus vaccine with every pregnancy, literally with every pregnancy, right? Between weeks 27 to 36, between weeks 27 to 36, that's very important to know for your exams. And then also anybody that is going to be a close contact, anybody that is going to be a close contact of a newborn should get the vaccine as well, should get the vaccine as well. That's the truth, right? So like, for example, they can give you a question on your exams where the father of the baby should get the vaccine or where the siblings of the baby should get the vaccine. Or where like grandma that's coming to come, uh, coming to help with the baby for a few months, you know, after delivery of the baby by his, his or her mom comes to help. That person should also get the vaccine. Keep that in mind. And then please do not forget, please do not forget, please do not forget that in general, you should get your vaccine boosters every 10 years.

Your vaccine boosters every 10 years. See, the tetanus vaccine is pretty high. You to know for your exams. That's why I'm really spending this time repeating myself, showing you all this logic. Now, the last thing I want to say is just some general testing advice, some general testing advice with vaccines because the thing is there is this erroneous knowledge out there that all you need to memorize with vaccines are just the guidelines. You could not be more sadly mistaken. Oh, just memorize the guidelines, the vaccine guidelines and your set. No, see, if that's the way they tested the vaccine guidelines, everybody will get a 280 on their exams. As we know, everybody does not get a 280 on their exams. Right. So the thing is, and this is something I emphasize very hard in my 50 hour class. And I've emphasized in many of my other classes, right? See, vaccines, they are certain things you want to know. You want to know like contraindications, right? Things that are not strict memorization that require more reasoning are things they love to test like, Hey, what are contraindications like? Hey, what are some vaccines that you should not give to a person that has an immunodeficiency disease? What are vaccines you should not give to a person that is less than a year old? What are vaccines you should not give to a person that is pregnant? What are the vaccines that are safe in pregnancy? Right? What are some vaccines you don't give if you have certain medical histories?

What are some vaccines you don't give if you for below certain city for thresholds? What are some vaccines you don't give if a child has a history of XYZ? Right? What are some principles you need to follow like if a child is in a certain medical state? Should you give this vaccine or not? Or, hmm, what are some vaccines where it's like, you got to wait for 20 like, like for example, you can get like, if you've if you recently got a live attended vaccine, you have to wait about 30 days before you get another live attended vaccine. If you're giving all the live attended vaccines at once, that's fine, not a problem. But if for example, they tell you in a queue, that a person got a live attended vaccine last week, you cannot give them another live attended vaccine this week. You have to wait for a couple of weeks, usually for a month before you give them another live attended vaccine, right? Or they talk about things like vaccine failures. It's like, hmm, this person, what happened, right? Or, you know, vaccines from the perspective of, hmm, okay, mom has this medical history. And she's in the process of Libra and delivery. What should we do to the newborn after the newborn is born? After the newborn comes out, after the newborn is born, right? These are all things you gotta think about. Or, ooh, you wear a close contact of XYZ. What vaccine should you get? Oh, when do you give just the immune globulina loan? When do you give the immune globulina plus the vaccine?

Or when do you give the vaccine a loan? Right? These are all technicalities and considerations you should not ignore. If you notice, many of these tips and tricks I'm giving, it's not the vaccine guideline that's going to help you answer it correctly. It's not, right? It's most some kind of physiological or pathophysiological reasoning that will help you answer these kinds of questions. I just figured I should kind of clear the ear on that. Because many people, they notice that, you know, especially for step two, step three, they're like, ooh, I've memorized all the vaccine guidelines. But I'm still getting a lot of vaccine questions wrong. It's because you're not, I'm not saying you don't need to memorize the guidelines. You gotta memorize the guidelines. But that probably comprises a lot less of what the USMLE's test than what most people imagine. The USMLE's they tend to go after more of these integrations with vaccines, right? Like for example, for example, for example, think about it. If a person has a history of the George syndrome, should you give them the rotavirus vaccine? You should not. Because the George syndrome is a semi-deated immune defect. Your third and fourth-firing geopolitics have not developed properly. If not, so you have no thymus, you literally have no T cells. When you have cell-mediated immune problems, it literally makes no sense to give a live-attended vaccine like the rotavirus vaccine. Ooh, okay.

That's the kind of question they can test on your exams, right? So please just kind of keep these things at the back of your mind as you study. If you're thinking of vaccines in this way, then you're going to be preparing for your exams, the way you should prepare for them. So I'm going to go ahead and stop the podcast here. If you like the way I teach, if you love these things I go over, you're going to absolutely love my classes. Again, as I said in my previous podcast, I've been getting a lot of really good feedback from people that took my classes recently. I've had people that took my class within the past month, within the past two months, that I've taken their exams, they've got in 270s, 260s, very high scores. They're like, man, I did much better than my practice tests on my real exam, right? So if you're interested in my classes, I have a bunch of classes that start tomorrow. For step one, all the way to three, I have a test-taking class tomorrow. It's in the evening. That's Tuesday, the 22nd of July, right? On the 23rd, I have a four-hour biostatistics class. On the 24th, that's a Thursday, I have a five-hour social sciences, quality improvement, hospital medicine, ethics review. Many people have taken these classes done extremely well. And then for step two and three specifically. On Friday, I have a three-hour last minute review. And then next week, I have a 20-hour step two step three review.

Again, these classes, they are very well updated, they're very well put together, they are all over Zoom, and they're going to help you do really well on your test. Right? So if you're interested, just shoot me an email and I can give you some more information on these classes. So thank you for listening to me in this podcast. I also offer one I want you to learn for all the USMLE and complex exams. And I help with ER As applications, personal statements, mock interviews, recommendation letters, edits, you know, all those things. And again, if you're taking your exams, you should take these classes soon. You know, I know many people are trying to get their scores in before ER As, right? You want to try to get your exams done by like the first week in September, the latest, right? So shoot me an email if you're interested. And my podcasts are also Apple Google and Spotify. And I also have a You Tube channel you can check out. And then I have another website. Finally, titled divineinterventionlifelessons.com. Thevineinterventionlifelessons.com. Many of you know I'm a Christian, a Christ follower, and every week, I post like one or two podcasts where from a biblical perspective address a life lesson. Many people actually listen to those podcasts and find them to be helpful. I actually made a podcast this morning, episode 351 on a preventive mindset.

It's something that actually I feel like we're really minister well to like medical students, physicians, residents, and people of that nature. There's actually an Apple podcast associated with that called the divineinterventionlifelessons podcast. I don't have the divineinterventionlifelessons podcast on Spotify or Google podcasts, but on Apple podcasts, I do have it. Or you can just go to the website, divineinterventionlifelessons.com. So thank you for listening to me today. I will see you God willing in episode 616 of a wonderful day. God bless you and bye for now. Thank you.

DTP (Diphtheria, Tetanus, Pertussis), Tdap (Tetanus, Diphtheria, acellular Pertussis), and Td (Tetanus, Diphtheria).

If the patient has completed their series AND it has been less than five years since the last shot.

1) When to give the active vaccine (immunization), and 2) When to give passive immunity (immune globulin). Do not merge these decisions.

People with a "wonky" vaccine history (unknown/incomplete series) OR immunocompromised individuals (e.g., HIV positive).

Every 10 years, unless specific wound criteria dictate otherwise.

Between weeks 27 and 36 of gestation.

More than 10 years.

More than 5 years (because it is a higher risk).

Unvaccinated status, unknown vaccination status, or failure to complete the primary vaccine series.

For clean wounds, regardless of patient status.

Wait approximately 30 days between giving two different live attenuated vaccines.

Tdap or Td, depending on whether pertussis coverage is needed/indicated.

More than 10 years.

More than 5 years (because it is a higher risk).

Unvaccinated status, unknown vaccination status, or failure to complete the primary vaccine series.

For clean wounds, regardless of patient status.

Wait approximately 30 days between giving two different live attenuated vaccines.

Tdap or Td, depending on whether pertussis coverage is needed/indicated.