In this article, we will consider the treatment and prevention of tetanus.
It is an infectious disease, the main symptom of which is convulsive muscle contraction. The causative agent of the infection enters the body through the wound surface, for example, there may be cracks, burns, scuffs, wounds or punctures. Treatment can give good results, but only on condition of early diagnosis, in some cases death is not excluded. This disease can also be prevented by performing a complex of vaccinations.
Tetanus prophylaxis 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 damaged skin. This disease is dangerous because its target is the human nervous system. Her defeat may be accompanied by severe convulsions, and, in addition, tension of the muscles of the skeleton.
Timely planned tetanus prophylaxis is very important.
Tetanus diagnosis
Tetanus is a disease in which a diagnosis is made only by actual clinical symptoms. The presence of a history of damage to the skin and mucous membranes is important. Thus, first of all, the doctor draws attention to operations, various bites, childbirth, abortion, as well as to the deep cracks that a person has. Particularly noteworthy are those injuries that were sustained during the previous month. It should be borne in mind that this or that injury could simply go unnoticed and even manage to heal by the time the symptoms of tetanus occur. The following symptoms should alert the person 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, tonic tension of the body occurs along with periodic convulsions with increasing temperature. Sweating may also occur. Such signs finally dispel any doubts, but this is already a late diagnosis. Tetanus prophylaxis is too late to take.
Laboratory diagnostic methods play almost no role in establishing this diagnosis. When the first symptoms of tetanus appear, exotoxin, which is excreted by the pathogen, already reaches the nervous system and it is simply impossible to detect it in human blood. Tetanus clostridia can be found directly in the wound by examination under a microscope of smear smears taken from the damaged area. Bacteriological methods are also sometimes used, within the framework of which wounds 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 has any significance, 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 in mice is used to confirm the presence of exotoxin. One mouse is injected with wound swabs in combination with a specific serum that can neutralize exotoxin. And to other rodents the same swabs are injected, however, already without serum. The second category of mice soon develops tetanus, which once again confirms the diagnosis.
When is emergency tetanus prophylaxis required? About it below.
Tetanus treatment
Tetanus therapy is carried out in an intensive care unit, since at any time a condition that threatens the patient's life may occur. Such a patient is not contagious to others, and, in addition, does not act as a source of spread of infection, in this regard, persons in contact with him are not at all in any danger. Therefore, no disinfection is carried out. But such a patient needs to observe bed rest.
Any therapeutic measures should be carried out almost simultaneously in order to have time to neutralize exotoxin along with its detrimental effect on the body. The sooner treatment is started, including specific therapy using immunoglobulin or tetanus toxoid, the more favorable the outcome will be and there will be more hope for complete healing.
How tetanus prophylaxis is carried out, we will tell later, but for now we will talk in more detail about the treatment of the disease.
A set of measures in the treatment of tetanus
The entire therapeutic complex of measures when tetanus appears 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 disposal of a dangerous toxin.
- Conducting treatment of seizures.
- Perform support for vital functions. In this case, the emphasis is on supporting breathing and cardiac activity.
- Symptomatic treatment. For example, it is necessary to lower the temperature, restore the volume of circulating blood, and so on.
- Conducting the prevention and treatment of complications.
- Quality organization of patient care.
It should be noted that the protective regime, in addition to constant monitoring of the patient's condition, also involves the creation of the most sparing conditions for the patient. In this case, the exclusion of any stimuli in the form of any sound, light and pungent odor is required. Such a patient should be provided with a minimum number of touches. 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 the surgical treatment of the lesion site with its tetanus toxoid. Surgical treatment consists in the complete removal of foreign bodies, and, in addition, dead tissue.
In addition, so-called strip incisions are made along the wound at the site of the lesion to create oxygen access to deeply located 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 managed to heal by the time the tetanus appeared, then this area is still punctured with tetanus toxoid in order to neutralize the remaining vegetative forms of infection. Such events are carried out under anesthesia in order not to provoke convulsions in the patient.
Toxin clearance
Toxin neutralization is carried out using tetanus antitoxic horse serum. Since exotoxin with tetanus has the ability to stable fixation on nerve cells (and after that it will simply be impossible to neutralize it in any way), serum administration should be started as soon as possible, immediately after the diagnosis is established.
Immediately before the introduction of serum, a test is mandatory to detect an allergic person to it. For this, 0.1 milliliters 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 edema is less than one centimeter, then the sample 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 health reasons as part of a special anti-shock treatment. In the presence of a negative sample, 0.1 milliliter of undiluted serum is administered intramuscularly. Then the patient is observed for about an hour. In the event that there were no complications, the entire necessary dose of the drug is administered intramuscularly. Serum is administered only once, and it lasts 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 supervision with the measurement of pressure, temperature and heart rate. Instead of this serum, doctors can use tetanus immunoglobulin. It is usually indicated in the presence of a positive allergic test for administration of horse serum.
Treatment for seizures with tetanus
The treatment of seizures is carried out with the use of sedative tranquilizers, and, in addition, with the help of neuroplegic elements, narcotic drugs and muscle relaxants, that is, drugs intended for muscle relaxation. Used in this case, drugs in the form of "Diazepam", "Sibazon" and "Relanium". They are taken orally by 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 patient's vital functions consists in correcting high blood pressure and impaired heart function. Also, in the process of treatment, it is necessary to carry out blood oxygenation. Doctors achieve a decrease in pressure along with a decrease in heart rate with the help of adrenergic blockers in the form of Obzidan, Anaprilin and Phentolamine.
If tetanus prophylaxis was not carried out in case of injury, the development of pathology is not excluded.
Symptomatic treatment
Symptomatic treatment primarily involves the fight against dehydration, and, in addition, with acidosis, against which the acid-base balance shifts towards an increase in acidity. For this, a four percent solution of sodium bicarbonate is used along with preparations in the form of Reopoliglukin, Reosorbilact, Reomacrodex, Refortan, Stabizol, Plazmalit, Ionosteril, Trisol and so on. Adequate intake of fluid provides a healthy volume of circulating blood, this prevents the temperature from rising even higher and reduces the risk of complications.
Since the development of tetanus due to muscle tension in the body disrupts ventilation, 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 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, providing him with clean bedding and underwear, 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 defecation, a person may need to have catheterization of the bladder along with regular cleansing enemas.
Due to the fact that tetanus is difficult to eat due to trismus, general muscle tension and dysphagia, and sometimes it is completely impossible, the patient’s nutrition is very important in this case. Given the ability to swallow, the patient is given liquid high-calorie food. Sometimes feeding is carried out through a tube or through the intravenous use of nutrient solutions.
Here's how important it is to consider indications for emergency tetanus prophylaxis.
In some cases, especially with the late treatment of the patient, or due to delayed diagnosis, any therapeutic measures are ultimately ineffective, and the patient dies. Currently, tetanus mortality is thirty percent. In this regard, much attention is currently being paid to the prevention of this dangerous disease. Next, we find out how tetanus prophylaxis is currently being carried out.
Preventive actions
There are two varieties:
- Nonspecific prevention. As part of it, injuries are prevented along with contamination of wounds. Tetanus prophylaxis is carried out as follows: sanitary-educational work is carried out, thorough treatment of damaged skin areas with timely dressings is carried out, aseptic rules in hospitals are observed.
- Specific - involves vaccination.
In turn, specific tetanus prophylaxis can be planned or emergency.
Routine prevention
Routine prevention involves vaccination. In order to ensure 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 prevented. Vaccinations are given for children aged three, four, five, six and eighteen months. The vaccine is then given at the age of six and at the age of fourteen intramuscularly into the thigh or shoulder region. Subsequently, throughout the course of life, revaccinations are carried out every ten years. It is believed that after administration of an toxoid at a dose of 0.5 milliliters for ten years, the human body retains the ability to produce antibodies to exotoxin. It is important to conduct tetanus prophylaxis in a timely manner for each 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 an toxoid at a dose of 0.5 milliliters twice every month, and then a year later. Such a three-time administration of the drug can provide the formation of immunity for ten years. Revaccinations every ten years will also be needed in the future.
Consider another type of tetanus prophylaxis.
Emergency prevention
This type of preventive measure is carried out in the presence of any type of injury with damage to the skin or mucous membranes. Also, specific emergency tetanus prophylaxis is used for animal bites, after abortions, childbirth, for burns and frostbite. It is advisable to carry it out in the presence of injuries of the abdomen and long-lasting purulent processes. Such prophylaxis is usually carried out up to twenty days inclusive from the moment of receiving skin damage. There are two types of emergency tetanus prophylaxis.
- Active type. It is carried out by previously vaccinated people. For this, 0.5 milliliters of toxoid is used.
- Active-passive type of emergency tetanus prophylaxis is carried out in relation to those people who were not vaccinated. In this case, the administration of 0.5 milliliters of toxoid is used in combination with tetanus toxoid human immunoglobulin. Instead of immunoglobulin, tetanus tetanus horse serum can be used. In this case, a lot depends on samples for an allergic reaction. After performing active-passive prophylaxis, it is required to continue the administration of the toxoid after a month, and then after a year. This is very important in order for a person to develop immunity to tetanus.
From the foregoing, it can be concluded that tetanus is a disease that is easier to prevent than to cure later. Conducting timely vaccinations reduces the risk of this disease to almost zero. A thirty percent mortality rate from developing tetanus speaks for itself. In this regard, people need to remember when they were last vaccinated from this disease. In the event that more than ten years have passed since the vaccination, then you must visit a medical institution and spend only five minutes on vaccination in order to protect your life in the future.
We examined the treatment and prevention of tetanus.