PREVENTING SURGICAL TETANUS

RISKS The risk of tetanus is small in a clean cut, minimally contaminated wound. But it can occasionally follow even a trivial one.

The risk of tetanus is great in burns, deep puncture wounds, injuries of the leg, thigh, buttocks, or axilla; in heavily contaminated wounds, especially crush injuries, and in wounds where there is much injured muscle, especially if they occurred on cultivated land, or if dung has been applied to the wound.

WOUND TOILET Toilet the patient’s wound thoroughly and leave it open.

WHAT TO DO TO PREVENT TETANUS

RISKS The risk of tetanus is small in a clean cut, minimally contaminated wound. But it can occasionally follow even a trivial one.

The risk of tetanus is great in burns, deep puncture wounds, injuries of the leg, thigh, buttocks, or axilla; in heavily contaminated wounds, especially crush injuries, and in wounds where there is much injured muscle, especially if they occurred on cultivated land, or if dung has been applied to the wound.

WOUND TOILET Toilet the patient’s wound thoroughly and leave it open.

WHAT TO DO TO PREVENT TETANUS

If you are sure the patient has had adequate tetanus toxoid previously, there are the following possibilities. (Adequate means two injections of toxoid, one of which must have been given during the previous 5 years).

If the risk is small, no further prophylaxis is necessary.

If the risk is great or doubtful, give him a booster dose of toxoid, and antitetanus immunoglobulin or serum (optional), and a megaunit of penicillin.

If he has not had adequate tetanus toxoid previously, assess the risks.

If the risk of tetanus is small, one dose of toxoid is enough.

If the risk is large or doubtful, give him toxoid, and a megaunit of penicillin, and antitetanus immunoglobulin, or serum. Continue penicillin for five days, or until his wound has healed. If his wound occurred more than 6 hours previously, his need for passive immunization is greater. Give him further doses of tetanus toxoid after 6 to 8 weeks and 4 to 6 months to complete his course.

IMMUNIZATION Immunize a patient on the indications given above. Give the antitoxin and the toxoid with different syringes in different sites.

Passive immunization If possible, give the patient antitetanus immune globulin of human origin (HTIG) (’Humotet’) 500 units intramuscularly. If you don’t have this, give him horse antitetanus serum 1500 units intramuscularly.

CAUTION! If you use antitetanus serum, test him for sensitivity. Inject 0.1 ml subcutaneously into his skin. Wait one hour. If there is any redness or any symptoms, he is allergic and should not have any more.

Active immunization Give an adult tetanus toxoid, 0.5 ml, intramuscularly. One dose gives little immunity, a second dose 6 to 8 weeks later gives more, a third dose 4 to 6 months later produces a high level of immunity. Give him another dose 5 years later, and every 10 to 15 years thereafter.

DIFFICULTIES IN PREVENTING TETANUS

If the REGIME ABOVE IS IMPRACTICAL, give all patients with any wound tetanus toxoid. If the risk of tetanus is high, give them prophylactic penicillin also.

GIVE TETANUS TOXOID TO ALL PATIENTS WITH WOUNDS