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tetanus

TETANUS

              tetanus is caused by a strong neurotoxin(tetanospasmin) made by strains of true bacteria tetani once introduced into the tissue that blocks repressive synapses on motor neurones in system, leading to unrestrained reflex spasm.

              The poison travels up native motor axons from the location of infection,causing native tetanus ,and spreads through the blood stream to succeed in several axons and thus the system. bone nerves area unit typically affected as a result of lock -how.
 PREDISPOSING FACTORS
wounds possibly to endanger tetanus area unit

 -those that treatment is delayed over concerning half-dozen hours

-those that is deep or contaminated with soil,metal,wood,calcium salt or bacterium

- those sophisticated by tube harm inflicting gangrene of muscles.
PORTAL OF ENTERY
1.puncture or war wound

2.otitis media

3.injection particularly shot of antimalarial drug or by narcotic addicts

4.unsterile surgery
-using infected cat gut
-infected swab
-criminal abortion
-ritual circumcision
-ear piercing

5.burns

6.animal bites and stings

7.firework injury

8.intrauterine death

9.unsterile devision of fetal membrane

10.compound fractures

11.humen bites

12.dental extractions

13.chronic skin ulceration or mortified limb

CLINICAL options OF TETANUS
INCUBATION amount
-usually half-dozen to ten days
PRODROMAL SYMPTOMS
Such as
-malaise
-fever
-sweating
-headache
-irritability
SYMTOMPS OF ESTABLISHED unwellness

(a)RIGIDITY
-rigidity affects the erector spinae and abdominal muscles manufacturing exaggerated body part spinal curvature,neck retraction and abdominal rigidity.

(b)MUSCLES SPASMS
manufacturing the standard look of raised eyebrows,tightly closed eyes and drawing back of lips to reveal tight teeth.

-OPISTHOTONUS - spasm of erector spinae muscles causes opisthotonus.

-in a lot of severe cases painful muscles spasm happens from time to time ,either spontanously or in response to stimuli like loud sound,injection,movement and tried naso-gastric canulisation.


-DISPHAGIA- attributable to spasm of tubular cavity muscles

-ASPHYXIATION-due to spasm of speech organ and metabolic process muscles.

-retention of excreta

-tremor is common.
SYMPTOMS attributable to SYMPATHETIC body process

patient with severe tetanus might develops

-cardiac arrhythmias
-fluctuating BP
-mark variation in rate
-impairment of rate of flow
-peripheral bask construction or vasodilatation
-increased matabolic rate
-pyrexia
-excessive sweating
-excessive secernment .
DIAGNOSIS
-Tetanus is make sure by biology.

-tissue sample or swab of the wound web site is taken for gram-staining and anaerobic culture.
MANAGEMENT
NEUTRALIZATION OF UNBOND poison

-hyperimmune human anti-tetanus immune globulin a thousand to3000 unite  I\'m/iv as single dose

-or anti-tetanus bodily fluid ten,000 unite iv once testing for sensitivity.
REDUCTION OF additional poison PRODUCTION

(a)CARE OF THE WOUND-removal of foreign material and surgical operation of non viable tissue of entry wound.

(b)ANTIBIOTICS-Benzyl antibiotic half-dozen00 mg half-dozen hourly i am or iv or tab Ilosone five hundred mg 6 hourly for ten days to reduce  risk of microorganism infection.
CONTROL OF RIGIDITY AND TETANUS SEIZURES
(a) AVOIDENCE of provocative stimuli-such as noise, supererogatory movement etc

(b)SEDATIVE medication

- inj Valium or inj chorpromazine or inj. ethanal trimer or injection analgesic salt. to manage cramp

-if on top of treatment can\'t management cramp  and seizere  then pressing surgical process and iatrogenic disfunction with improvement support ought to be started.
AUTONOMIC CIRCULATORY DISTURBANCE management

@HYPOTENSION- fluid if volume depletion

@HYPERTENSIVE SPELL- tab propranolopropranolol five mg po or 5mg organ calcium blocker or each

@BRADYRHYTHMS -Aatrppin iv.
NURSHING SUPPORT

(a)ICU-moderate and severe cases ought to be breast-fed in unit

(b)NUTRITION-continuous drip feeding via nasogastric or nasojejunal tube

(c)GENERAL MEASURES AND physical therapy to stop bed sores .
PREVENTION

1.IMMUNIZATION-with oneml tetanus antigen to be continual once three months  or 3 dose of 1 mil every at three to four weeks interval .

2.TREATMENT OF WOUND
-Through cleansing,removal of foreign material and surgical operation of death tissue with use of antimicrobial answer and ceam.

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