Management,Prognosis,Pencegahaan, Treatment and Complications

E. Management 

GENERAL

• Maintain and clean the wound as well as possible.
• Diet adequate calories and protein, form of food depending on the ability to open his mouth and swallow. If there is food to be given personde trismus or parental.
• Insulation to avoid external stimuli such as sounds and actions of the patient.
• Oxygen, artificial respiration and tracheotomy if necessary.
• Adjust the balance of fluid and electrolyte
• DRUGS
• Anti-toxin

Tetanus immune globulin (TIG) is more than the recommended use of anti tetanus serum (ATS) of the animal.
The recommended initial dose is 5000 TIG U intramuscularly recommended daily dose of 5000-6000 U. when giving TIG is not possible, the ATS can be given at a dose of 5000 U intravenously. Giving only implemented after it was confirmed there was no hypersensitivity reactions.

• Anti-seizure
• Types of drugs commonly used are:
• Diazepam, at a dose of 0.5 to 1.0 mg / kg body weight / hour intramuscular, side effects Sopor and coma.
• Meprobamat, at a dose of 300-400 mg / 4 hours intramuscularly, has no side effects.
• Klorpromasin, with a dose of 25-75 mg / 4 hours intramuscular, efeksamping hypotension.
• Phenobarbital, at a dose of 50-100 mg / 4 hours intramuscular, side effects of respiratory depression.
• • Antibiotic

Procaine penicillin 1.2 million units / day or intravenously 1g/hari tetracycline, can destroy Clostridium tetani but does not affect neurological processes.

 
G. Prognosis
Tetanus has a mortality rate of up to 50%. Death usually occurs in patients who are very young, very old, and injecting drug users. If symptoms worsen immediately or if treatment is delayed, the prognosis worsens.
Influenced by several factors that can aggravate the situation, namely:

1. The incubation period is short (less than 7 days)
2. Neonates and older age (over 55 years)
3. Seizure frequency is often
4. High body temperature rise
5. Medications that slow
6. Period trismus and convulsions are more frequent
7. The existence penyulitan respiratory muscle spasm and airway obstruction

 H.Pencegahaan, Treatment and Complications
A.prevention
Prevention of tetanus include:

• Prevent injury
• Maintain adequate wounds
• The provision of anti-tetanus serum (ATS) within a few hours after the injury will provide passive immunity, thereby preventing the occurrence of tetanus will prolong the incubation period or if there is ttetanus mild symptoms.
• Usually given in a dose of 1500 U intramuscularly after skin and eye tests.
• Provision of tetanus toxoid in children who have never received active immunization in the following weeks after the ATS, then repeated again with a distance of 1 month 2 consecutive
• Provision of procaine penicillin for 2-3 days after receiving serious injuries (50.000U/kgBB/hari dose).
• Active immunization. Tetanus toxoid is given to the child's immune active form. So that is supplied with basic vaccinations against pertussis and diphtheria vaccination, starting at age 3 months. Repeat vaccination (booster) given 1 year later and at the age of 5 years and thereafter every 5 years with diphtheria toxoid (without pertussis vaccine).

In the event of serious injury to a child who had received tetanus toxoid immunization or 4 years ago, then to him shall be given to the prevention of antitoxin and toxoid injections at the same time on both extremities (different injection site).
B. Treatment

• To neutralize the poison, administered tetanus immunoglobulin. Tetracycline and penicillin antibiotics given to prevent the formation of toxins lebeh further.
• Other drugs may be given to calm patients, controlling seizures dann relax muscles. Patients are usually hospitalized and placed in a quiet room. For moderate to severe infections, may need a ventilator to assist breathing.
• Food is given through a nasogastric tube or intravenous infusion. To remove dirt, catheter. Patients should lie alternately tilted to the left or to the right and forced to cough to prevent pneumonia.
• To reduce the pain be codeine. Other drugs given to control bias in blood pressure and heart rate. After recovering, should be given full vaccination for tetanus infection does not confer immunity against subsequent infections.
• Anti-Toxin: ATS 500 U IM followed by a daily dose of 500-1000 U
• Anti anticonvulsants and sedatives: Violent seizures when given a starting dose of phenobarbital is for age less than 1 year, and 50 mg for children aged 1 year given 75 mg. Followed by a dose of 5 mg / kg / day, for 6 doses.

Diazepam at a dose of 4 mg / kg / day, divided 6 doses, if necessary, can be given intravenously.
Largaktil a dose of 4 mg / kg / day, divided 6 doses. When seizures can be difficult to overcome kloralhidrat 5% at a dose of 50 mg / kg / day in 3-4 divided doses, given perrektal.

• biotic Anto: procaine penicillin 1.2 million U / day
• Diet should be enough calories and protein. Consistency of food depends on the ability to open her mouth and swallow. When there are trismus, given liquid food through a hole. If necessary given parenteral nutrition.
• Insulation to avoid stimuli (sound, action on the patient). Treatment room should be quiet.
• If you need to be given oxygen and sometimes necessary measures to avoid tracheostomy airway obstruction.
• Children are encouraged to be treated in the Special Care Unit when the state obtained:

1. Seizures are difficult to overcome with medication antikonvulasan usual.
2. Spasm of the larynx.
3. Complications that require intensive care such as airway obstruction, respiratory failure, hyperthermia and so on.

C. complication

• Bronkopneumoni
• Afaksia
• Cyanosis
• pharyngeal muscle spasm that causes the accumulation of saliva (saliva) in the oral cavity and this allows that to happen teerjadinya aspiration pneumonia aspiration
• atelectasis due to obstruction by a secret
• fracture

Objective data

• The occurrence of increased blood press
• Pain in the muscles
• An increase in muscle tone
• Usually the patient is weak
• Appears anxious
• Movement Limited
• In a move supported
•  Looks pale
• Looks weak
• Usually patients are restless
• Usually patients withstand pain
• Decreased appetite
• Awareness of decreased
• Strong and fast Nadi
• Decrease the value function gianjal keratinin far from normal
• palpable abdominal teasa hard as a board
• Saying daaerah jaw pain
• Board looks stiff