Tetanus. Health care

FUNDAMENTALS OF FIRST AID
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Tetanus. Health care

Fundamentals of First Aid (OPMP)

Tetanus is an acute infectious disease with a contact mechanism for the transmission of the pathogen. It is characterized by damage to the central nervous system with tonic tension of the skeletal muscles and periodic generalized convulsions. The causative agent is the bacillus Clostridium tetani from the Bacillacaea family of the Clostridium genus. Anaerobe, with access to oxygen and a temperature not lower than 12-14 ° C, forms spores. Produces an exotoxin that affects the nervous system and causes the destruction of red blood cells (erythrocytes). Reproducing forms of the microbe die at 80 ° C after 30 minutes, conventional antiseptic and disinfectant solutions kill the pathogen within 3-6 hours. Spores in the soil can persist for more than 10 years. When boiled, they die after 1 hour, and in an iodine solution, hydrogen peroxide survives up to 6 hours. Under the action of dry heat at 115 ° C, they die within 30 minutes.

Reservoir and exciter sources - herbivores, rodents, and also humans: the pathogen lives in the intestines and is widely dispersed in the external environment with feces, remaining in the soil for a long time.

The mechanism of transmission of the pathogen - contact. The transmission route is traumatic, through damaged skin and mucous membranes (wounds, burns, frostbite), where particles of soil, manure or feces contaminated with the pathogen enter. Contaminated medical instruments and other cutting and stabbing objects can also serve as transmission factors.

The natural susceptibility of people is high, the likelihood of disease increases with a large area of tissue damage, when oxygen access to damaged tissues is hindered (anaerobic conditions). In torn, bruised, gunshot wounds, the tetanus bacillus falls into ideal conditions for its life activity.

The incubation period lasts from several hours to 1 month, usually 6-14 days. The shorter the incubation period, the higher the risk to the life of the affected person.

Main clinical signs. The onset is subacute or acute. Consistently there is a spasm of the masticatory muscles and tonic tension of the facial muscles, muscles of the neck, chest, diaphragm, back, shoulders and hips. After 1-5 days, attacks of generalized convulsions develop, muscle pains, sweating, tachycardia, difficulty in swallowing, breathing, urinating, defecation occur. The temperature is raised, consciousness is preserved. Recovery occurs within 2 weeks to 2 months. Death usually occurs from paralysis of the respiratory muscles; lethality from 15 to 35%.

Prevention of tetanus is carried out in a planned manner, by introducing tetanus toxoid in medical institutions at the place of residence and on an emergency basis (for the wounded and burned) at the points of emergency medical care.

Widespread vaccination made it possible to significantly reduce the incidence, but tetanus did not completely disappear. In Russia, several dozen cases are registered annually - mainly among the unvaccinated or not fully vaccinated. The disease is more common among women, as the male population is vaccinated during military service.

Tetanus is especially prevalent in developing countries among newborns, who lack maternal antibodies due to the fact that the mother was not vaccinated, or because of artificial feeding. According to WHO (World Health Organization) estimates, 400 thousand deaths among newborns due to the development of tetanus are recorded annually in the world.

The only means of prevention is vaccination, the effectiveness of which is 95-100% (data from I. V. Plyushch et al. for 2000).

Necessary equipment for open injuries: analgesics in a syringe tube, a standard tourniquet, an individual dressing bag, bandages, cotton wool, scarves, transport tires, 5% alcohol solution of iodine, sanitary stretchers.

Authors: Aizman R.I., Krivoshchekov S.G.

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