Test with answers on the topic “Current issues in tetanus immunoprophylaxis”

Tetanus

Today, when going to the emergency room for a wound or injury with a violation of tissue integrity, in addition to emergency measures, tetanus prophylaxis is mandatory. It is indicated for those people who do not have vaccinations against infection or have had them for a long time.

A toxoid, immunoglobulin or anti-tetanus serum is administered. How is emergency prevention carried out, to whom is toxoid, serum or immunoglobulin administered?

First aid for tetanus infection

At the slightest threat of infection, urgent measures must be taken.

Tetanus toxin begins to be produced in huge quantities and spreads throughout the body, poisoning it. The effects on the brain and heart are especially dangerous.

The first step is emergency hospitalization.

Treatment at home at this stage is unacceptable and can be fatal. In the hospital, the wound will be opened (thus providing access to oxygen, which is detrimental to the pathogen), treated, after which the infected person will be given a vaccine.

Further measures are aimed at maintaining vital functions, preventing complications and proper care.

Are all wounds dangerous?

If it is a minor wound, cut or scratch, treated on time, properly treated and not contaminated with soil, it is the least dangerous in relation to tetanus.

It is a completely different matter if the wound is caused by rusty, blunt or soil-contaminated objects, it is extensive, or it is an animal bite. The causative agents of this disease are widely represented in the external environment; they actively live in oxygen-free conditions and can penetrate into the wound with particles of dust, earth, and dirty water. In the absence of immunity to tetanus, such tissue damage can become a source of infection.

Therefore, emergency prevention is carried out if:

The wound is contaminated with soil, splinters, and metal particles.

There are crushed, non-viable tissues.

The patient presented later 6-12 hours from the moment of injury.

When deciding on the administration of anti-tetanus drugs, it is necessary to study the medical history, have DTP vaccinations (for children) and DTP revaccinations every 10 years (for adults).

Tetanus symptoms

Tetanus does not appear immediately, but after a fairly long incubation period - up to a week. Sometimes this period is completely asymptomatic, but more often general manifestations of intoxication are noted:

• weakness and sweating,
• irritability and headache.

Locally, there is a sensation of muscle twitching in the wound. Immediately before the initial stage, a sore throat appears when swallowing, insomnia and loss of appetite, and back pain.

Initial period

It is characterized by pain in the area of ​​an already healed wound, tension and contraction of the masticatory muscles, and the inability to unclench the teeth and open the mouth. Lasts up to 2 days.

High period

Contraction and spasms of the facial muscles, spasm of the pharyngeal muscles and tension of the neck appear. The muscles of the limbs, back and abdomen are involved in the process.

Convulsions occur, increasing in time and extent of distribution - in severe cases, convulsions last without interruption. Insomnia, shortness of breath, suffocation, and cyanosis occur. Duration – from 8 to 12 days.

Recovery

The period is gradual and long – up to two months.

Tetanus, if vaccinated

Children who receive 4 vaccinations in the first years of life have sufficient immune protection against infection - three in the first year, and a fourth at one and a half years. Then immunity is maintained through revaccination at the age of 6-7 years - before school, and then after 10 years - at 16-17 years. In this case, wound treatment does not require additional measures for emergency prevention of tetanus. Immunity after vaccinations is quite tense.

It’s a completely different matter if these are adults who, after school, have never been to a vaccination office and have not received the ADS vaccine (it contains toxoid for tetanus and diphtheria). To fully prevent tetanus, adults should be vaccinated every 10 years - this is 26-27 years, then 36-37 years, and so on. If these are separate groups of patients for whom vaccinations are necessary, as permission to work or a special need (military, military school students, doctors), the question of emergency prevention does not arise. For other people who do not have reliable protection against infection, a special approach is required.

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Prevention and measures in the outbreak

It is necessary to monitor the hygiene and integrity of the skin. Micro trauma to the skin, abrasions, abrasions, and diaper rash should be avoided. Timely treatment of eczema, fungal skin diseases, as well as sanitation of foci of streptococcal infection is important. To avoid infection of the patient with streptococcus, strict adherence to the rules of asepsis during medical procedures in surgical, obstetric and other hospitals is required.

To prevent recurrent erysipelas, effective treatment of the primary disease is important. For those suffering from recurrent erysipelas, bicillin prophylaxis is indicated - administration of bicillin-5 at a dose of 1.5 million units intramuscularly monthly for 3-4 months. For frequent relapses of erysipelas, bicillin-5 is administered for 2-3 years.

Control questions

1. What causes and how does infection occur during erysipelas?

2. Factors contributing to the occurrence of erysipelas.

3. Main clinical manifestations of erysipelas.

4. What diseases are used for differential diagnosis?

5. Principles of therapy and prevention.

6. How are preventive and anti-epidemic measures carried out in the outbreak?

7. Make a plan for a conversation about preventing erysipelas.

Tetanus is an acute infectious disease characterized by damage to the nervous system and manifested by tonic and clonic convulsions.

Etiology. The causative agent - Clostridium tetani is a large, thin rod with rounded ends. The pathogen has flagella, is mobile, gram-positive, is a strict anaerobe, and is highly sensitive to the action of oxygen. The microbe produces spherical spores located terminally, which gives them the appearance of a drumstick. The spores are extremely resistant to physical and chemical environmental factors. The spores can withstand boiling for one hour; in a 1% solution of formaldehyde, iodine, and hydrogen peroxide they live for up to 6 hours. Spores persist in the soil for years and even decades. Under anaerobic conditions at a temperature of 37 0 C and sufficient humidity, spores germinate into vegetative forms. The vegetative form is not very stable and dies when boiled after five minutes.

The pathogen is heterogeneous in its antigenic structure. There is a group somatic O-antigen and a type-specific flagellar H-antigen, which distinguishes 10 bacterial serovars.

The causative agent of tetanus produces two types of exotoxin: tetanospasmin and tetanohemolysin. Tetanospasmin is a neurotoxin and causes the main clinical manifestations of the disease. Tetanohemolysin destroys (dissolves) red blood cells. Exotoxin is one of the most powerful bacterial poisons, second in strength only to botulinum toxin. The toxin is quickly inactivated under the influence of heat, sunlight, and an alkaline environment. Enzymes of the gastrointestinal tract do not destroy the toxin, it is not absorbed through the intestinal mucosa, and therefore is safe when administered orally.

Antibiotics of the penicillin and tetracycline series have a bacteriostatic effect on vegetative forms of the microbe, but do not affect its toxin.

Epidemiology. Tetanus bacillus lives in the intestines of herbivores and in 5–40% of people. In the intestine they exist in the form of spores or vegetative forms that produce a toxin, which, however, is not absorbed. Everywhere, the tetanus microbe is found in the soil when it enters it with animal feces, transforming into a spore form.

The mechanism of transmission of infection in tetanus is contact due to the penetration of spores or vegetative forms of the microbe into the human body through damaged skin and, less often, mucous membranes. A particularly common cause of infection is microtrauma of the lower extremities (62–65%). The disease can develop due to burns and frostbite, in women giving birth when the rules of asepsis are violated, during criminal abortions, in newborns (contamination of the umbilical wound), especially during home birth.

Wartime tetanus is associated with extensive wounds and thermal tissue damage.

Susceptibility to tetanus is high. Rural residents get sick more often. Tetanus occurs throughout the world, affecting 300–350 thousand people every year.

Immunity is not formed after an illness.

Transmission of the pathogen from a sick person is not observed.

Pathogenesis. The entry point for infection in tetanus is damaged skin and mucous membranes. Particularly dangerous are puncture wounds and those with deep pockets, where anaerobic conditions are created that promote the proliferation of tetanus bacillus and the release of toxin.

The toxin moves along the motor fibers of the peripheral nerves and with the blood flow into the spinal cord, medulla oblongata and into the reticular formation of the trunk. At neuromuscular synapses, the toxin leads to disruption of neuromuscular transmission processes. In the central nervous system, tetanus toxin causes nerve impulses to flow uncoordinatedly and continuously to the muscles, causing constant and tonic tension.

Damage to the reticular formation of the brain stem leads to disruption of the respiratory and vasomotor centers with possible cessation of breathing and cardiac activity.

The effect of the toxin on the sympathetic nervous system causes tachycardia, unstable arterial hypertension, arrhythmia, spasm of peripheral vessels, and severe sweating.

Clinic. The incubation period ranges from 5 to 14 days, in some cases it is shortened to 1 – 4 days or extended to 30 days.

Against the background of constant muscle hypertonicity, excruciating, sharply painful tetanic (clonic) spasms occur, initially limited, then widespread, covering large muscle groups. Attacks of convulsions last from several seconds to several minutes and deplete the patient’s strength, their frequency depends on the severity of the disease. In mild cases, they appear no more than 1–2 times a day, in severe cases they continue almost continuously, with several dozen attacks per hour. Even minor stimuli, for example, auditory, visual, touch, light, can provoke seizures. During an attack of convulsions, the patient’s face turns blue, becomes covered with large drops of sweat, expresses severe suffering, facial features are distorted, opisthotonus becomes more pronounced, and the contours of the muscles of the neck, torso and arms are clearly visible. Patients experience feelings of fear, grind their teeth, scream and moan in pain, and often bite their tongue. Convulsions of the respiratory muscles, glottis and diaphragm dramatically disrupt breathing and can lead to death.

The consciousness of patients remains clear throughout the entire period of the disease, which aggravates the suffering of patients. Convulsions are accompanied by painful insomnia, unresponsive to sleeping pills and narcotics. Body temperature is elevated (39 – 40 0 ​​C), profuse sweating is evident.

The activity of the cardiovascular system is disrupted: tachycardia is pronounced, heart sounds are muffled. Neutrophilic leukocytosis is observed in the peripheral blood.

Excessive seizures often lead to fractures of vertebrae and other bones.

Maximum clinical manifestations increase approximately by the third day of illness, and then they remain stable for 5 to 7 days. After about 10 days, convulsive attacks begin to decrease, and by the end of the second week they completely stop. However, muscle stiffness may remain for a long time. Most surviving patients recover completely within 4 to 6 weeks.

Based on severity, the following forms of tetanus are distinguished: 1) mild (I degree); 2) moderate (II degree); 3) severe (III degree); 4) very severe (IV degree).

Local tetanus

in humans it is rare and is characterized by muscle damage in the wound area, where pain appears, then muscle tension and tetanic spasms.

Complications of tetanus

– asphyxia, pneumonia, muscle and tendon ruptures, bone fractures. Gynecological tetanus and neonatal tetanus are often complicated by sepsis.

The prognosis is almost always serious. Mortality is 20 – 25%.

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Emergency prevention of tetanus involves primary surgical treatment of the wound and the creation, if necessary, of specific immunity against tetanus. Emergency immunoprophylaxis should be carried out as early as possible from the moment of injury, up to the 20th day, taking into account the length of the incubation period for tetanus.

Tetanus Immunity: Tension Control

If an adult does not have information about vaccinations (does not remember whether they were given or there are no entries in the card), immunity to tetanus can be assessed at the time of treatment regarding the injury. The level of specific toxoid in blood plasma is determined by express analysis. Its result is prepared quickly; less than 1 ml of blood is sufficient for testing (from the wound itself, from a finger when taking other tests, from a vein).

Tetanus is dangerous when the volume of toxoid in plasma is less than 1 IU/ml. If testing is not possible and there is no evidence of vaccination, the patient is considered unvaccinated, at risk of tetanus, and full prophylactic measures are required.

Tetanus vaccination after injury: is it necessary?

A tetanus shot, given after an injury, is one of the most common methods to help prevent such a dangerous disease.

The development of a pathological process accompanied by damage to the nervous system is difficult to treat therapeutically and can therefore result in death. The reason is that the respiratory system is paralyzed and the person suffocates.

What kind of disease is this

Tetanus is part of a group of neuroinfectious diseases that can affect not only the human body, but also animals.

According to statistics, people living in rural areas are more susceptible to the disease. This is due to the long-term presence of the infectious pathogen in the soil.

It is important to remember that tetanus cannot be transmitted through contact with a sick person. Infection, as a rule, is provoked by pathogens when they come into contact with an injured area.

It is not the microorganism itself that poses a particular danger to the human body, but its metabolic products, since they contain strong poison.

On average, the disease develops from three to fourteen days. However, the time frame may extend to 30 days. It is also worth noting that with a more distant location of the lesion from the central nervous system, the incubation period will be longer.

Is it necessary to do

Some situations require unscheduled administration of a tetanus vaccine. As a rule, vaccination is carried out after injury.

This measure is extremely necessary to prevent the penetration of bacterial toxins into the body through wound skin surfaces, which leads to an increased risk of developing an infectious disease.

Unscheduled vaccination to prevent tetanus is carried out in the following situations:

• Dirt, manure, and particles of earth were found in the wound;
• the injury occurred as a result of a cut on glass, if a person stepped on a rusty nail or drove a wooden splinter under the skin;
• suffered frostbite;
• there was a clandestine abortion;
• when a woman is pregnant;
• there are foreign objects in the wound surface;
• there was an injury in which the damaged tissues were in close contact with a hard object or were sandwiched between them (for example, a fairly heavy structure fell on the leg);
• bitten by an animal or another person (similar cases have also been recorded).

The vaccine is also necessary if you receive a second or third degree burn, which puts the victim at increased risk of becoming infected with pathogenic toxins.

The vaccine must also be administered in case of injury with the formation of necrotic tissue. Since there is no possibility of supplying them with blood, the likelihood of infection increases. Such situations include gangrene, the formation of abscesses and ulcers, the healing of which does not occur for a long time.

In general, tetanus vaccination is given even when injured with a completely clean object..

This measure is necessary when the last vaccine was administered more than ten years ago.

The following drugs are used for unscheduled vaccination:

• adsorbed tetanus toxoid;
• purified concentrated equine anti-tetanus serum;
• human tetanus immunoglobulin;
• adsorbed diphtheria-tetanus toxoid with a reduced amount of antigens.

Before vaccination, a person is tested for the development of a reaction by administering a small amount of the drug. In the absence of characteristic manifestations, an injection is given to the drug with the introduction of the full volume of serum.

How quickly should you get vaccinated?

Since the incubation period of the disease is at least 3 days, vaccination against tetanus should be done, if possible, within several hours after injury. However, it should be noted that if the last immunization was carried out no more than 5 years ago, then this event is absolutely useless.

Where is the injection given?

The vaccine is given through intramuscular injection. In order for the blood to penetrate inside faster, the serum must be injected into the deep layers of the muscle.

To achieve maximum effect, an area with thin skin, where muscle tissue is well developed and a small amount of fatty tissue predominates, is suitable. If the drug penetrates the skin, an abscess or phlegmon may begin to develop. To prevent such consequences, it is not recommended to use the buttocks.

For adults, the drug is usually injected into the shoulder area or under the shoulder blade. For infants and children under three years of age - in the thigh.

After the procedure, experts do not recommend visiting places with large crowds of people, since at the time of vaccination the patient’s immune system weakens, which can provoke the development of an infectious respiratory disease.

Where can you get qualified help?

If a person is seriously injured, he must immediately go to the emergency room or clinic at his place of residence.

To carry out emergency vaccination, you will need:

• compulsory health insurance policy;
• referral from a general practitioner or pediatrician.

When you don’t have time to wait, you can use the paid services of a private clinic. An emergency tetanus vaccination will cost about 400 rubles.

Is there any benefit

When promptly sought medical help, vaccination helps protect a seriously injured patient from a dangerous disease such as tetanus. However, it is important to remember that you need to get the injection as quickly as possible.

The vaccine cannot be fully guaranteed if it was administered, for example, a week after the injury. In addition, it is useless to give an injection if the last revaccination was carried out more than 10 years ago.

Features of childhood vaccination

It is necessary to give an emergency vaccination in case of injury to a child only after checking the data on the vaccination card, since further treatment tactics will be selected based on this information:

• when vaccinated according to all standard rules, an additional injection is not given;
• if the vaccination is done on time, but there is no last revaccination due to age, anti-tetanus toxoid is administered;
• if there are only 2 scheduled vaccinations, the duration of which is no more than 5 years, AS is also administered, over five years - a milliliter of toxoid and 250 IU of human immunoglobulin are used;
• if the child has not been vaccinated, IPCH (human tetanus immunoglobulin) is administered up to 5 months.

It is also important to pay attention to the nature of the wound, whether it is infected or not . The tetanus vaccination schedule will also depend on this.

How long does the course last?

The full course of immunization depends on whether the person was vaccinated as a child or not.

So, for an unvaccinated adult, injections are given according to the following scheme:

• vaccine in a double dose, 30 days apart;
• the third – 12 months after the first two.

Then revaccination is carried out every 10 years.

In childhood, vaccinations are given five times, according to a special schedule. The first revaccination is carried out in adolescence (14-16 years).

When vaccination after injury is not necessary

For a minor cut or puncture, such as a finger, there is no need to go to a medical facility for a vaccine. In addition, there are certain contraindications in which tetanus vaccination is not given in case of injury.

These include:

• immunodeficiency in any form;
• individual intolerance to components;
• acute diseases and exacerbation of chronic ones;
• development of complications caused by the same vaccination.

If possible, injections are carried out after the condition has stabilized.

What consequences can there be after the vaccine?

Each body is individual, and the reaction to vaccination can be unpredictable.

Side effects are as follows:

• the general condition sharply worsens, lethargy, anxiety appear, there is no appetite, vomiting may begin;
• a lump appears at the injection site;
• an allergic reaction occurs in the form of swelling and redness of the skin;
• when infection penetrates, the temperature rises;
• Quincke's edema or anaphylactic shock appears;
• convulsive syndrome;
• collapsed state.

For minor complications, it is enough to use symptomatic medications. If the situation is serious, specialist advice will be required.

Conclusion

Tetanus is a serious disease that can be fatal in certain cases. Any serious injury can lead to the development of the disease. To prevent this from happening, you must immediately seek help from a medical facility for emergency vaccination.

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Source: https://naprivivku.ru/vzroslym/privivka-ot-stolbnjaka-posle-travmy.html

What drugs are used: toxoid, serum

For emergency prevention of tetanus infection when treating wounds, the following types of drugs are used:

• Tetanus toxoid, adsorbed (abbreviated AS).
• Adsorbed diphtheria-tetanus toxoid (ADT-m), the prefix denotes a reduced concentration of antigens.
• Antitetanus serum (ATS), made on the basis of horse hyperimmune plasma, thoroughly purified, concentrated. One dose of serum contains 3000 IU of active substance.
• Anti-tetanus human immunoglobulin (ATHI). One dose contains 250IU of active components.
• Of all these compounds, serum is the most reactogenic and dangerous drug. It can cause severe allergic reactions to administration, including shock. In this regard, before administering the serum, a mandatory skin test is indicated.

Test with answers on the topic “Current issues in tetanus immunoprophylaxis”

To this day, tetanus remains one of the most severe infectious diseases. According to the World Health Organization, immunization prevents 2 to 3 million deaths each year from diphtheria, tetanus and measles. In the Russian Federation, as a result of the implementation of a nationwide system of tetanus immunization, only sporadic incidence is recorded annually among older age groups of the population, mainly unvaccinated. In recent years, there has been a danger of an increase in the incidence of tetanus due to a decrease in the number of vaccinated adults. Unlike other infections, in which the role of herd immunity is important, with tetanus the decisive factor is the protection of each person. In this regard, a further reduction in morbidity will depend on the completeness of active immunization coverage of the population, the timeliness of revaccination and the adequacy of emergency immunization against tetanus in case of injuries. Tetanus remains a public health problem in 25 countries, predominantly in Africa and Asia, where vaccination coverage remains low to date.

1. Frequency of training of specialists on compliance with the “cold chain”

1) 2 times a year with a note in a special journal; 2) 3 times a year with a note in a special journal; 3) once a year with a note in a special journal. +

2. To maintain immunity against tetanus at a sufficient level, it is necessary to carry out revaccination by single administration of drugs containing AS toxoid, with an interval

15 years; 2) 1 year; 3) 15 years; 4) 10 years. +

3. After administration of PSS (3000 IU), monitor the patient for

1) 30 minutes; 2) 60 minutes; + 3) 40 minutes; 4) 20 minutes.

4. A drug used for routine revaccination against tetanus in adults

1) PSS; 2) PSCH; 3) ADS-M; + 4) DPT.

5. One prophylactic dose of tetanus toxoid serum (tetanus toxoid)

1) 3,000 IU; + 2) 30,000 IU; 3) 250,000 IU; 4) 50 IU.

6. The route of transmission that leads to tetanus

1) water; 2) food; 3) transmission; 4) through damaged skin and mucous membranes (wound). +

7. The causative agent of tetanus Clostridium tetani is

1) gram-positive spore-forming rod, aerobic; 2) gram-negative spore-forming rod, anaerobe; 3) gram-negative spore-forming rod, aerobic; 4) gram-positive spore-forming rod, anaerobic. +

8. Place of intradermal test

1) shoulder; 2) upper outer quadrant of the buttock; 3) flexor surface of the forearm; + 4) thigh.

9. Drugs used for vaccination against tetanus in children

1) ADS; + 2) PSS; 3) PSCH; 4) DPT. +

10. General cleaning of the refrigerator and disconnecting it from the power supply is carried out

1) once a week; 2) once a quarter; 3) 1 time per month. +

11. To store immunobiological drugs, a “cold chain” system is created, which is

1) a smoothly functioning system that ensures optimal temperature conditions for storing all medications that require protection from elevated temperatures; 2) a set of organizational, sanitary and anti-epidemic (preventive), technical, control and supervisory, educational, methodological and other measures to ensure optimal conditions for transportation and storage of medical products at all stages (levels) of their movement from manufacturer to consumer; + 3) a set of organizational, sanitary and anti-epidemic (preventive), technical, control and supervisory and other measures to ensure optimal storage conditions for IMP at the production stage.

12. Emergency immunoprophylaxis of tetanus should be carried out until

1) up to 30 days from the date of injury; 2) up to 10 days from the date of injury; 3) up to 15 days from the date of injury; 4) up to 20 days from the date of injury. +

13. Accounting for the reaction of a subcutaneous test is carried out through

1) 60 minutes; 2) 20 minutes; 3) 30 minutes; + 4) 15 minutes.

14. Emergency immunoprophylaxis for tetanus is carried out

1) after verbal instructions from a doctor; 2) independently by a nurse, without a doctor’s prescription; 3) after a written prescription from a doctor. +

15. The full course of routine vaccination against tetanus in children includes

1) only the first vaccination at three months; 2) vaccination at three months and revaccination at 18 months; 3) first vaccination at 3 months, second vaccination at 4.5 months, third vaccination at 6 months and revaccination at 18 months; + 4) first vaccination at 3 months, second vaccination at 4.5 months, third vaccination at 6 months.

16. Human tetanus immunoglobulin (HAI) 250 IU is administered

1) intradermally; 2) subcutaneously; 3) intravenously; 4) intramuscularly. +

17. Tetanus is used for emergency immunoprophylaxis

1) DTP; 2) PSCH; + 3) PSS; + 4) AC. +

18. When carrying out active-passive prophylaxis of tetanus, adults are given

1) conditions and techniques for emergency prophylaxis of tetanus; 2) PSS (3000 IU); 3) 1.0 ml AC; 4) 1.0 ml AS and PSS (3000 IU); + 5) 0.5 ml AS and PSCH (250 IU).

19. Monitoring of the readings of each thermometer and temperature indicator with recording of the readings in a special journal is carried out

1) 2 times a day; + 2) 1 time per day; 3) 3 times a day.

20. Indications for emergency prophylaxis of tetanus are

1) closed bone fractures; 2) out-of-hospital abortions; + 3) osteomyelitis; + 4) any injuries that damage the integrity of the skin and mucous membranes. +

21. In the cold chain system there are

1) 5 levels; 2) 3 levels; 3) 4 levels; + 4) 2 levels.

22. Antitetanus serum (3000 IU) is administered for emergency prophylaxis of tetanus

1) intradermally; 2) subcutaneously; + 3) intravenously; 4) intramuscularly.

23. To carry out a subcutaneous test, use

1) 0.1 ml PSS (3000 IU); + 2) 0.5 ml PSS diluted 1:100; 3) 0.1 ml PSS diluted 1:100; 4) 1.0 ml of PSS at a dilution of 1:100.

24. For persons who have a reaction to an intradermal or subcutaneous test, further administration of PSS

1) indicated after prescribing antihistamines; 2) contraindicated; + 3) indicated as prescribed by a doctor.

25. An intradermal test is considered positive if

1) there is no swelling or redness at the injection site; 2) the diameter of redness and swelling at the injection site is 1.0 cm or more; + 3) the diameter of redness and swelling at the injection site is less than 1.0 cm.

26. To carry out an intradermal test, use

1) 0.1 ml PSS diluted 1:100; + 2) 1.0 ml PSS diluted 1:100; 3) 0.5 ml of PSS at a dilution of 1:100; 4) 0.1 ml PSS (3000 IU).

27. The purpose of nonspecific tetanus prophylaxis

1) early and thorough surgical treatment of wounds; + 2) routine immunoprophylaxis of tetanus; 3) emergency immunoprophylaxis of tetanus due to injuries; 4) prevention of injuries at home and at work. +

28. Emergency prevention of tetanus is

1) in primary surgical treatment of wounds and simultaneous specific immunoprophylaxis; + 1) only in specific immunoprophylaxis of tetanus; 1) only in the primary surgical treatment of the wound.

29. A system that provides the necessary conditions for storage and transportation of immunobiological preparations from the manufacturer to the vaccinated person is called

1) cold chain; + 2) temperature regime; 3) storage mode.

30. One prophylactic dose of human tetanus immunoglobulin

1) 30,000 IU; 2) 250,000 IU; 3) 3,000 IU; 4) 250 IU. +

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Emergency prevention

Today, more and more people, especially adults, forget that vaccinations must be repeated regularly and lose the immunity they have developed. And such a person goes to the doctor with a possibly infected injury; emergency prevention is necessary.

To exclude possible exposure to tetanus toxins, the victim is administered a serum containing a specific immunoglobulin.

Two types of such serum are used: horse and human. The first is obtained from the blood serum of hyperimmunized horses, the second - from vaccinated human donors.

Important! Like any foreign protein, such serum after administration can cause an allergic reaction from the immune system.

Therefore, emergency prophylaxis is resorted to only in cases where it is known that the victim is not vaccinated, if he does not have confirmation of all necessary vaccinations or the course has not been completed.

Before introducing the serum, an allergy test is required - a few milligrams are injected under the skin and the reaction is monitored for half an hour.

The administration of antitetanus serum is an effective method of combating possible infection. But it can cause complications: allergic local reactions, Quincke's edema, anaphylactic shock, and so on.

The likelihood of serum sickness can be reduced by administering antihistamines at the same time. They do not affect the effectiveness of prevention.

At the same time, people and children who are weakened and prone to allergic reactions and hypersensitivity to medications are given human serum whenever possible, but it is not always available.

Important! Serum is not a replacement for vaccination, and is much more difficult to tolerate. So, refusing vaccination, hoping to administer serum if necessary, is quite dangerous.

Emergency prophylaxis must be carried out as quickly as possible, but no later than the 20th day after the wound was inflicted.

Treatment of tetanus

Therapy for this disease includes three main areas:

• Fighting the pathogen. To do this, if necessary, the wound is sanitized, dead tissue is cleaned out and it is completely treated, and a course of antibiotics is also prescribed.
• Neutralization of the toxin. Antitetanus serum is used. The number and volume of injections depend on a large number of indicators, primarily the severity of the disease, age and weight of the patient. Also, special therapy is prescribed to speed up the elimination of toxins.
• Prevention of complications. This is the most difficult and important part, because it is complications that most often lead to the death of the patient.

Typical complications of tetanus are cardiac paralysis, myocardial infarction, auto-fractures of bones, ruptures of muscles and tendons during an attack, respiratory failure and asphyxia, toxic damage to the brain, liver, kidneys, as well as pneumonia, pulmonary edema, and thrombosis.

Therefore, treatment first of all helps to cope with convulsive seizures, which are becoming more severe and longer every day. In mild cases, it is enough to transfer the patient to a quiet, darkened room, eliminate possible irritants, and prescribe muscle relaxants and sedatives.

In severe cases, a ventilator is used to prevent asphyxia during an attack, nutrition is supplied through a tube or intravenously, and urine is drained through a catheter. Often in such cases, narcotic drugs are used to relieve seizures.

In addition, treatment includes a wide range of drugs that support the patient’s body, primarily the functions of the heart, liver, and kidneys.

As a rule, the acute period lasts 3-4 weeks. The middle of this period is considered the most difficult - from 10 to 14 days. If it can be safely passed, the chances of successful treatment are significantly increased. After the turning point, the patient’s condition gradually improves, convulsive seizures become less frequent and weaker until they pass.

Long-term complications include pneumonia, as well as damage to the nervous system: paralysis, spasms, muscle weakness. Full recovery may take up to 3-4 months. In some cases, after recovery, complications such as muscle weakness, tachycardia, and spinal curvature persist.

After treatment in a hospital setting (2-3 months), a long rehabilitation period is required to restore the nervous system and muscles.

Tetanus is one of the most serious bacterial diseases, and anyone can encounter it. Proper and timely prevention can really protect you from it.

One of the most dangerous bactericidal diseases is tetanus. When the disease occurs, a person experiences various disorders in the nervous system with the simultaneous appearance and further progression of tonic tension in all skeletal muscles. In addition, the patient experiences genialized convulsions.

The cause of the disease is considered to be tetanus bacillus. Scientists have determined that this pathogen can survive well in the external environment, where it exists in the form of spores. It was determined that the spores under study react poorly to all kinds of antiseptics and disinfectants. They are not afraid of high temperatures - they can maintain their viability at a temperature of 90 C for 2 hours. The spore is in dormant “mode” until favorable conditions arise:

• anaerobic environment is required;
• a certain humidity is required;
• temperature 37 C.

When the necessary conditions are reached in the environment, then the spores germinate into certain forms, which produce toxins so hostile to the human body. Only botulinum toxin is considered more dangerous than tetanus.

Children suffer from tetanus most often between the ages of 3 and 7 years. They get sick mainly in the summer. Residents of rural areas are more often susceptible to infection with this disease.

Human infection occurs as a result of tetanus entering a wound or cut on the patient’s body. Even very minor scratches and wounds are dangerous. But deep wounds resulting from careless handling of sharp objects are extremely dangerous. Having received damage, it is necessary to immediately treat the wound, since tetanus bacteria are found everywhere: soil, dust, manure. Infection with tetanus is dangerous because it leads to spasm of a person’s muscles, especially the respiratory and chewing muscles.

The bacterium Clostridium tetani is the causative agent of this disease. When it enters the human body through a wound on the body, it forms a toxin, and this already causes the symptoms of tetanus in the patient. There is a risk group; newborns, due to the nature of their work, must constantly receive injections.

How to treat tetanus

If a patient is diagnosed with tetanus, treatment begins with external hospitalization. In order to neutralize tetanus toxins, the patient is injected with tetanus serum. Along with it, a special immunoglobulin can be administered. In order to reduce the convulsive syndrome, the infected person is given sedatives, narcotic drugs, as well as neuroleptic drugs.

If the patient has difficulty breathing, resuscitation measures are carried out:

• laxatives are prescribed;
• a gas outlet pipe is installed;
• if necessary, bladder catheterization is performed.

Antibiotics are used in the treatment of tetanus; they are used to prevent bacterial complications in the patient. Sodium bicarbonate solution, polyonic solutions, hemodez are administered to the patient intravenously to combat dehydration.

People who become ill with this disease are admitted to the intensive care unit under the close supervision of an anesthesiologist-resuscitator. This is absolutely necessary, since the statistics of this disease have a high mortality rate - 40%.

It is advisable to place such people in a separate room and create the most calm conditions for them (the patient’s senses should be irritated as little as possible); complete rest is necessary. Food intake occurs using a gastric tube, and in case of urgent need, parenterally.

Since the patient is on strict bed rest, he needs to undergo constant prevention of bedsores. It involves periodically unwrapping the patient, constantly straightening and changing bed linen in a timely manner, and constantly cleaning the patient’s skin. The wound through which the infection occurred should be treated with anti-tetanus serum. This is done even if the wound through which the infection occurred has already healed. In addition, the wound is opened and dead tissue is removed, after which surgical treatment of the injured area is performed. These activities are carried out under anesthesia.

As part of the etiological treatment, the patient is given anti-tetanus serum; this must be done as early as possible.

Summarizing all of the above about the treatment of tetanus, we can highlight the main steps in the treatment of this disease:

1. Urgent hospitalization of the patient and placement in a separate room. At the same time, it is necessary to provide him with complete rest.
2. Organization of special nutrition, which is associated with spasms of the swallowing muscles. At the same time, devices for drainage of urine and feces are organized.
3. The attending physician prescribes sedatives and narcotics to the patient to alleviate the patient’s condition during painful convulsive attacks.
4. Other medications are intended to normalize the patient and to prevent his stopping. If there is no desired effect from this type of medication, the patient is connected to artificial respiration.