In this article, we will look at the treatment and prevention of tetanus.
It is an infectious disease, the main symptom of which is convulsive muscle contraction. The causative agent of infection enters the body through the wound surface, for example, it can be cracks, burns, abrasions, wounds or punctures. Treatment can give good results, but only if diagnosed early, in some cases a fatal outcome is not ruled out. This disease can also be prevented through vaccinations.
Tetanus prevention is of interest to many.
What do we know about tetanus?
This disease is caused by a bacterial pathogen. Infection is carried out by the contact method, in which microorganisms enter the bloodstream through the damaged skin. This disease is dangerous because its target is the nervous system.human system. Its defeat may be accompanied by severe convulsions, and, in addition, tension in the tone of the muscles of the skeleton.
Timely routine tetanus prophylaxis is very important.
Diagnosis of tetanus
Tetanus is a disease in which the diagnosis is made on the basis of actual clinical symptoms only. The presence of a history of damage to the skin and mucous membranes is important. Thus, first of all, the doctor pays attention to operations, various bites, childbirth, abortions, as well as to deep cracks that a person has. Particularly noteworthy are those injuries that were received during the previous month. It should be borne in mind that this or that injury could simply go unnoticed and even have time to heal by the time the symptoms of tetanus appear. A person should be alerted by the following symptoms in the form of the presence of pulling pain in the wound or the presence of muscle twitching above the site of injury.
In the event that trismus appears along with a sardonic smile and dysphagia, the combination of which is characteristic only for tetanus, then the diagnosis becomes obvious to the doctor. Following the characteristic triad, there is a tonic tension of the body along with periodic convulsions with an increase in temperature. Sweating may also occur. Such signs finally dispel any doubts, but this is already a late diagnosis. It is too late to take tetanus prevention measures.
Laboratory diagnostic techniques play almost no role in establishingthis diagnosis. When the first symptoms of tetanus appear, the exotoxin that is released by the pathogen already reaches the nervous system and it is simply impossible to detect it in human blood. It is possible to find Clostridium tetanus directly in the wound by examining smears taken from the injured area under a microscope. Bacteriological methods are also sometimes used, in which swabs from the wound are placed on a nutrient medium and, thus, bacteria are artificially grown. However, in terms of time frame, this study no longer matters, since by this moment the clinical picture of the disease no longer causes any doubts among specialists.
Sometimes, along with bacteriological methods, a biological test on mice is used to confirm the presence of an exotoxin. One mice is injected with wound swabs combined with a specific serum that can neutralize the exotoxin. And other rodents are injected with the same swabs, however, already without serum. The second category of mice soon developed tetanus, further confirming the diagnosis.
When is emergency tetanus prophylaxis required? More on that below.
Tetanus treatment
Tetanus therapy is carried out in an intensive care unit, as a life-threatening condition can occur at any time. Such a patient is not contagious to others, and, moreover, does not act as a source of infection, in connection with this, persons in contact with him are not exposed to any danger at all. That's whyno disinfection is carried out. But such a patient needs to stay in bed.
Any therapeutic measures should be carried out almost simultaneously in order to have time to neutralize the exotoxin along with its harmful effects on the body. The sooner treatment is started, including specific therapy with the use of immunoglobulin or antitetanus serum, the more favorable the outcome will be and there will be more hope for a complete cure.
How tetanus prevention is carried out, we will tell later, but for now let's talk more about the treatment of the disease.
Complex of measures in the treatment of tetanus
The whole medical complex of measures for the appearance of tetanus can be systematized as follows:
- Compliance with the protective regime, in which the patient is under the constant supervision of specialists.
- The behavior of the fight against the pathogen in the area of its penetration into the body, that is, directly in the wound.
- Complete neutralization of dangerous toxin.
- Treatment for seizures.
- Performing vital support. In this case, the emphasis is on supporting breathing and heart activity.
- Performing symptomatic treatment. For example, it is necessary to reduce the temperature, restore the volume of circulating blood, and so on.
- Prevention and treatment of complications.
- Quality organization of patient care.
It should be noted that the security mode, in addition to constant monitoring of the statethe patient also involves the creation of the most gentle conditions for the patient. In this case, the exclusion of exposure to any irritants in the form of any sound, light and pungent odor is required. Such a patient should receive a minimum amount of touching. This is very important in order not to provoke convulsions.
The fight against the causative agent of the disease in the area of penetration into the body involves surgical treatment of the lesion site with chipping it with tetanus toxoid. Surgical treatment consists in the complete removal of foreign bodies, and, in addition, dead tissues.
Among other things, so-called lamp incisions are made along the wound at the site of the lesion to create oxygen access to deep-lying tissues. This is done in order to cause disastrous conditions for the existence of clostridia, since in the presence of oxygen they cannot develop. In the event that the wound has managed to heal by the time the tetanus occurs, then this area is still chipped with anti-tetanus serum in order to neutralize the remaining vegetative forms of the infection. Such activities are carried out under anesthesia in order not to provoke convulsions in the patient.
Toxin neutralization
Toxin neutralization is carried out with the help of anti-tetanus antitoxic horse serum. Since exotoxin in tetanus has the ability to stable fixation on nerve cells (and after that it will simply be impossible to be able to neutralizeby any means), serum administration should begin as soon as possible after diagnosis.
Immediately before the introduction of serum, a test is mandatory to identify a person's allergy to it. To do this, 0.1 milliliter of serum is injected under the skin in the middle of the forearm. Twenty minutes later, the injection site is evaluated. In the event that redness with swelling is less than one centimeter, then the test is considered negative and this indicates that there is no allergy.
If such redness reaches one centimeter or more, then this means that the introduction of this serum is possible only for he alth reasons as part of a special anti-shock treatment. In the presence of a negative sample, 0.1 milliliter of undiluted serum is injected intramuscularly. Then the patient is observed for about an hour. In the event that there are no complications, the entire required dose of the drug is administered intramuscularly. The serum is injected only once, and it lasts for about three weeks.
Due to the possibility of anaphylactic shock, which is an acute allergic reaction that threatens the life of the patient, within one hour after the introduction of serum, the patient is subject to mandatory medical observation with the measurement of pressure, temperature and heart rate. Doctors may use tetanus immunoglobulin instead of this serum. It is usually indicated in the presence of a positive horse serum injection allergy test.
Tetanus Seizure Treatment
Convulsions are treated with sedativestranquilizers, and, in addition, with the help of neuroplegic elements, narcotic drugs and muscle relaxants, that is, drugs designed to relax muscles. In this case, drugs are used in the form of "Diazepam", "Sibazon" and "Relanium". They are taken orally at 10 milligrams every four hours. If it is impossible to swallow the medicine, the medication is administered intravenously at 10 milligrams up to eight times a day.
Supporting the vital functions of the patient is to correct high blood pressure and heart failure. Also in the process of treatment, it is necessary to carry out blood saturation with oxygen. Pressure reduction along with a decrease in heart rate, doctors achieve through the use of adrenergic blockers in the form of Obzidan, Anaprilin and Fentolamine.
If tetanus prophylaxis has not been carried out in case of injury, the development of pathology is not excluded.
Providing symptomatic treatment
Symptomatic treatment primarily involves the fight against dehydration, and, in addition, with acidosis, against which the acid-base balance shifts towards increased acidity. For this, a four percent sodium bicarbonate solution is used along with drugs in the form of Reopoliglyukin, Reosorbilact, Rheomacrodex, Refortan, Stabizol, Plasmalite, Ionosteril, Trisol and so on. Adequate fluid intake ensures a he althy volume of circulating blood, this keeps the temperature from rising even higher and reduces the riskcomplications.
Since the development of tetanus due to muscle tension in the body disrupts the ventilation of the lungs, antibiotics of different groups are used to prevent pneumonia, these can be macrolides, penicillins or cephalosporins with tetracyclines. Antibiotics are prescribed in the second week in high doses. Preventive measures include the subcutaneous use of "Heparin" in order to prevent thrombosis.
As part of the prevention of the development of bedsores, the patient is often turned in bed, ensuring that his bed and underwear are clean, it is possible to use special anti-decubitus instruments in the form of rollers, pillows, rings, and the like. Since muscle tension leads to impaired urination and bowel movements, a person may need a bladder catheterization along with regular cleansing enemas.
In view of the fact that with tetanus it is difficult to eat due to trismus, general muscle tension and dysphagia, and sometimes it is completely impossible, the organization of the patient's nutrition plays a very important role in this case. Provided that the ability to swallow is preserved, the patient is given liquid high-calorie food. Feeding is sometimes done through a tube or intravenous administration of nutrient solutions.
Here's how important it is to consider indications for emergency tetanus prophylaxis.
In some cases, especially when the patient is treated late, or due to delayed diagnosis, any therapeutic measures eventually turn out to be ineffective, and the patient dies. Currentlythe death rate from tetanus is thirty percent. In this regard, much attention is currently paid to the prevention of this dangerous disease. Read on to find out how tetanus prophylaxis is currently implemented.
Prevention measures
There are two varieties:
- Non-specific prophylaxis. As part of it, injuries are prevented along with contamination of wounds. Prevention of tetanus is carried out as follows - sanitary and educational work is carried out, careful treatment of damaged skin areas with timely dressings is carried out, asepsis rules are observed in hospitals.
- Specific - involves vaccination.
In turn, specific tetanus prophylaxis can be elective or emergency.
Planned Prevention
Planned prevention involves vaccination. As part of ensuring the development of immunity from this disease, tetanus toxoid is used. It is included in combination vaccines. At the same time, diphtheria and tetanus are being prevented. Vaccinations are given to children at the age of three, four, five, six and eighteen months. Then the vaccine is given at the age of six and at the age of fourteen intramuscularly in the thigh or shoulder area. In the future, throughout life, revaccinations are carried out every ten years. It is believed that after the introduction of toxoid at a dose of 0.5 milliliters for ten years, the human body retains the ability toproduction of antibodies to exotoxin. It is important to provide timely tetanus prophylaxis for every child.
In the event that such immunization was not carried out in childhood, that is, an adult is not vaccinated against tetanus at all, then he is given toxoid at a dose of 0.5 milliliters twice with an interval of a month, and then a year later. Such a three-fold injection of the drug can provide the formation of immunity for ten years. In the future, revaccinations every ten years will also be required.
Let's consider another form of tetanus prophylaxis.
Emergency Prevention
This type of preventive measure is carried out in the presence of any kind of injury with damage to the skin or mucous membranes. Also, emergency specific prophylaxis of tetanus is used for animal bites, after abortions, childbirth, burns and frostbite. It is advisable to carry it out in the presence of abdominal wounds and long-term purulent processes. Such prophylaxis is usually carried out within a period of up to twenty days, inclusive, from the moment the skin injury is received. There are two types of emergency tetanus prophylaxis.
- Active type. It is given to previously vaccinated people. For this, 0.5 milliliters of toxoid is used.
- Active-passive type of emergency tetanus prophylaxis is given to people who have not been vaccinated. In this case, the introduction of 0.5 milliliters of toxoid in combination with antitetanus human immunoglobulin is used. Can be used instead of immunoglobulintetanus toxoid horse serum. In this case, much depends on the tests for an allergic reaction. After performing active-passive prophylaxis, it is required to continue the introduction of toxoid after a month, and then after a year. This is very important for a person to develop immunity to tetanus.
From the foregoing, we can conclude that tetanus is a disease that is easier to prevent than to subsequently cure. Timely vaccination reduces the risk of this disease to almost zero. And the 30% mortality rate from advanced tetanus speaks for itself. In this regard, people are required to remember when they were last vaccinated against this disease. In the event that more than ten years have passed since the vaccination, then you need to visit a medical facility and spend only five minutes on vaccination in order to protect your life in the future.
We covered the treatment and prevention of tetanus.
