Tetanus

Tetanus is not contagious between persons, so -- while normal medical prophylacsis should be maintained, no special procedures are required. Tetanus is a bacterium, Clostridium tetani, often found out of doors in soil or excrement, tending to prosper is damp, warm places. The epidemiology of tetanus is that it is easily preventable with vaccines, so it is far less common in financially advanced countries, and for more prevalent in countries that can't afford a widespread program of vaccination. Once contractred, C. tetani is frequently fatal, with 11% M&M in reported cases (which is actually misleading in that Europe and North American cases are rare and not as often fatal).

Tetanus attacks the skeletal and later the cardiac muscles (hence the name lockjaw). This makes is difficult to treat. Moderate cases can be treated with a 10-day course of Flagyl IV, using diazapam (push, PRN) to help, and of course, tetanus immune globulin adminsitered IV or IM.

Severe cases are handled in the ICU. The patient may not be able to breath for themselves, so intubation is a consideration, as is a continuous IV of diazapam as well as magnesium. Note also, lytes will almost certainly be abnormal as the disease runs its course. As this is a muscular effective, be prepared to handle rapidly changing hyper and hypotensive episodes.

Specific Nursing COnsiderations include:

• While a very dangerous disease, it's not (easily) communicable1.
• Lots of IV's in a convulsive patient spell trouble with sharps; be Very alert. Restraints are problematic in that the patient is not in control of the spasms, and so you cannot assume that pain will act to slow the patient down; be prepared for potental damage from restriants, if used.
• Cardiac and respiratory problems abound, so constant observation in severe cases is called for, even more than is usual in ICU's. Personally, I'd go with actual visual observation and not rely solely in telemetry.
• In addition to the anitbiotic, supportive, and diazepam lines, be aware ahead of time that this will present a confusing case in a logistic sense.
• As tetanus is far more prevalent in countries with rural populations and comparitively depressed economies, be prepared for the overall medical situation one encounters in such countries, e.g. supply issues, rarer diseases, nutritional issues, prophylacsis, language difficulties, different epidemiology, etc. To the extent that you can be, be prepared for supply shortages and do what you can to offset.
• Note that neonatal tetanus does in fact exist and should be a consideration in administering childbirths.

1 While all my text books tell me this disease is hard to contract in general, and cannot be contracted directly from the patient, I have to confess that I would be personally inclined to treat it as I would a blood-born pathogen in the way I'd handle the scene. I realize this is not in keeping with current views of this (in the West) rare disease. And I've never had direct experience with this disease.

A tetanus shot is an injection that vaccinates the recipient from an acute bacterial disease also known as tetanus or lockjaw.

A tetanus shot contains the tetanus toxoid - which is an inactivated form of the toxin Clostridium tetani.

The vaccination against tetanus is normally included in a combined vaccine called DTaP that protects against diphtheria, tetanus, and whooping-cough (pertussis).

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tetanus

toxoid

You will get sick?

There are several possibilities. Maybe nothing will happen. Maybe the puncture will become infected...watch for reddening around the wound for a few days. If it becomes infected, see a doctor. Tetanus infection is a possibility, but in the case of a thumb tack that was fairly clean, it is unlikely. If the wound develops an infection, the doctor will test for tetanus and, if found, will treat it. If the thumb tack was out-of-doors, or in a dirty environment like a garage or barn, see a doctor without delay.

Clostridia are saprophytic organisms. The genus contains some of the most dangerous pathogens known to man. (Clostridium perfringens - Gangrene, Food poisoning - Clostridium botulinum - Botulism, Clostridium difficile -Pseudomembranous colitis) C tetani's tetanus toxin (known as tetanospasmin) is an anaerobic rod that is lethal, but it is not as dangerous, as the botulinum toxin produced by C. botulinum.

As with all clostridial wound infections, trauma to the host tissue is the initial event in tetanus, followed by contamination of the wound with C tetani. Without the damage to the tissue, the anaerobic bacteria cannot survive. The damage creates an environment with a potential for reduced oxidation- which is necessary for anaerobic growth. Once growth is initiated, the organism itself stays confined to the necrotic tissue, where the vegetative cells of C tetani elaborate the lethal toxin Tetanospasmin.

The incubation period for C tetani, from contamination to first symptoms depends on the site of the wound and the dose of the bacteria. The further away from the central nervous system, the longer the incubation; a large dose of bacteria in a wound in the upper arm, chest or head may only take a few days, while the infamous rusty nail to the foot - may take several weeks.

The two animal species most susceptible to this toxemia are horses and humans.