Diagnosis and treatment of tetanus

Diagnosis with a characteristic clinical picture is not difficult.
When uncertain, erased the clinical picture and the early phases of development tetanus should be differentiated from poisoning by strychnine, encephalitis, a tetany, rabies, hysteria and others Careful examination of the anamnesis and clinical manifestations allows to make a differential diagnosis, but at the slightest suspicion on a tetanus should immediately start treatment.
Forecast with tetanus unfavourable mortality reaches 40-70%.
Treatment. If you suspect a tetanus patient urgently hospitalized; create absolute rest, placed in a private room (Boxing), darken Windows. Open and close the door with great caution so as not to create noise, provide round-nursing post. You can't turn the patient during feeding, changing of bed linen and treatment procedures. In connection with the fact that opening of the mouth in patients is difficult, food must be liquid and high-calorie. The patient is fed from the drinking bowl or through a tube.
Treatment starts with the introduction of anti-tetanus serum on Besedke (see Besedki method). Single dose for adults 100 000 - 200 000 ME; the serum is injected intramuscularly and only in very severe cases, intravenous within 2 to 3 days in a row. At the same time appoint toxoid by 1.5-2 ml in the first day of treatment and then repeat 2 more times after 3-5 days.
To reduce anxiety and stop convulsions give chloral hydrate in enemas (1.5 grams per 100 ml of broth starch); 5-10 ml of 25% solution of magnesium sulfate intramuscularly.
From neurologically funds used aminazin on 1-4 ml of 2.5% solution intramuscularly 4-8 times a day. Dose dependent on the gravity of the course of tetanus. Since the introduction of the drug painful, it should be diluted with novocaine. Usually in combination with chlorpromazine used curariform tools: kondelin, Latin, diplatsin and other
From the first days of treatment for the prevention of complications of postoperative wound infections, pneumonia - prescribe antibiotics (penicillin, streptomycin) standard dosage. For improvement of cardiac activity appoint kordiamin, camphor, korglykonum, to improve breathing oxygen.
If the patient has unhealed wound, it is necessary to carefully handle and leave open.
In severe tetanus in the house should be prepared all the necessary emergency assistance: adrenaline, chlorpromazine, strofantin, glucose (40% solution), sterile syringe, asymmetrical, oxygen, sterile tools for tracheotomy, ready-to-use instrument for artificial respiration and other
Prevention. To produce active immunity apply toxoid (see Immunization). In case of wounds, abrasions, burns, illegal abortions is administered anti-tetanus serum dose of 3000 ME. If the injuries are required careful treatment of wounds.