RESUMO
INTRODUCTION: Tetanus is a preventable infectious disease with vaccination. Cephalic tetanus is the rarest form in which local tetanus can involve the cranial nerves. CASE: Herein, we report a case of cephalic tetanus in a 16-month-old girl who had never been vaccinated. The patient, who had a complaint of a wound on the cheek mucosa for 2 weeks, was seen playing with the soil in the garden 1 week ago and was found to have abundant soil removed by her mother. The patient was diagnosed as cephalic tetanus according to her complaints and clinical findings. DISCUSSION: We believe that, this is the first case reported in the literature of cephalic tetanus in such a young child wherein the disease focus of infection from a wound on the cheek mucosa. The symptom we defined as 'a child who cries when she smiles' presented in this case could only be associated with this disease. CONCLUSION: In addition to detailed anamnesis and meticulous physical examination, the clinical symptoms that we have described for the first time in a child with cephalic tetanus should also be considered for early and accurate diagnosis.
Assuntos
Nervos Cranianos/microbiologia , Mucosa Bucal/lesões , Tétano/diagnóstico , Infecção dos Ferimentos/microbiologia , Administração Intravenosa , Feminino , Humanos , Lactente , Injeções Intramusculares , Metronidazol/administração & dosagem , Penicilinas/administração & dosagem , Tétano/tratamento farmacológico , Antitoxina Tetânica/administração & dosagem , Toxoide Tetânico/administração & dosagem , Resultado do Tratamento , Infecção dos Ferimentos/complicaçõesRESUMO
Background: Reports suggest that, in tetanus, magnesium sulphate (MgSO4) alone may control muscle spasms, thereby avoiding sedation and mechanical ventilation. Aim: To study the efficacy and safety of intravenous MgSO4 in controlling spasms and rigidity in children with tetanus. Methods: All children with tetanus consecutively admitted over a 2-year period in a tertiary-care teaching hospital were recruited. In addition to human tetanus immunoglobulin and parenteral metronidazole, patients received MgSO4 100 mg/kg intravenously followed by infusion at 40 mg/kg/hr. The infusion rate was increased by 5 mg/kg/hr every 6 h until cessation of spasms or abolition of the patellar tendon reflex. Efficacy was determined by control of spasms. Time to commencement of feeds, frequency of autonomic instability, the need for ventilatory support, duration of hospitalisation and mortality were also recorded. Results: Twenty-seven children with tetanus aged between 18 months and 10 years were recruited. A contaminated wound was the most common portal of entry of tetanus spores. The incidences of severity were: grade I, 3; grade II, 7; grades IIIa and b, 17. Rigidity and spasms were controlled by magnesium therapy alone in 14 patients. Additional sedation was required for 13 patients (grade II, 1; grade III, 12). Feeding could be commenced early in five patients. Mechanical ventilation was required in eight patients. The mean (SD) duration of hospitalisation was 26.5 (12.0) days. Five patients died (18.5%). Asymptomatic hypocalcaemia was a universal finding and was treated with calcium supplements. Conclusion: MgSO4 alone is effective in mild-to-moderate tetanus but not when it is severe.
Assuntos
Sulfato de Magnésio/administração & dosagem , Espasmo/tratamento farmacológico , Tétano/tratamento farmacológico , Anti-Infecciosos/administração & dosagem , Hospitais Universitários , Humanos , Infusões Intravenosas/efeitos adversos , Sulfato de Magnésio/efeitos adversos , Metronidazol/administração & dosagem , Centros de Atenção Terciária , Antitoxina Tetânica/administração & dosagem , Resultado do TratamentoRESUMO
Tetanus remains a significant burden in many low- and middle-income countries. The tetanus toxin acts within the central nervous system and intrathecal antitoxin administration may be beneficial, but there are safety concerns, especially in resource-limited settings. We performed a pilot study to assess the safety and feasibility of intrathecal human tetanus immunoglobulin in five adults with tetanus before the conduct of a large randomized controlled trial. Intrathecal injection via lumbar puncture was given to all patients within a median 140 (range 100-165) minutes of intensive care unit (ICU) admission. There were no serious adverse effects associated with the procedure although three patients had probably related minor adverse events which resolved spontaneously. Median ICU length of stay was 14 (range 5-17) days. Two patients required mechanical ventilation and one developed a deep vein thrombosis. Within 240 days of hospital discharge, no patients died and all patients returned to work.
Assuntos
Imunoglobulinas/administração & dosagem , Imunoglobulinas/uso terapêutico , Injeções Espinhais/métodos , Tétano/tratamento farmacológico , Adulto , Estudos de Viabilidade , Humanos , Imunoglobulinas/efeitos adversos , Injeções Espinhais/efeitos adversos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Ensaios Clínicos Controlados Aleatórios como Assunto , Antitoxina Tetânica/administração & dosagem , Antitoxina Tetânica/uso terapêutico , Resultado do TratamentoAssuntos
Antídotos/administração & dosagem , Mordeduras e Picadas , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/diagnóstico , Traumatismos do Pé/diagnóstico , Pé/inervação , Antitoxina Tetânica/administração & dosagem , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Animais , Diabetes Mellitus Tipo 2/fisiopatologia , Diagnóstico Diferencial , Traumatismos do Pé/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Ratos , Resultado do Tratamento , Inibidores de beta-Lactamases/uso terapêuticoRESUMO
A 1-week-old infant was brought to a regional hospital with a history of recurrent seizures following lower abdominal septic skin infection. She was found to have neonatal tetanus, and a spatula test was positive. The tetanus infection was associated with a superficial skin infection, common in neonates. Treatment included sedatives (diazepam, chlorpromazine, phenobarbitone and morphine), muscle relaxants, antibiotics and ventilation in the neonatal intensive care unit. Intrathecal and intramuscular immunoglobulin were given, and the wound was treated. The infant recovered, with no seizures by the 16th day from admission, and was off the ventilator by the 18th day. This was shorter than the usual 3 - 4 weeks for neonates with tetanus at the hospital. The question arises whether tetanus immunisation should be considered in infants with skin infections, which frequently occur in the neonatal period.
Assuntos
Antibacterianos/administração & dosagem , Anticonvulsivantes/administração & dosagem , Diagnóstico Tardio , Hipnóticos e Sedativos/administração & dosagem , Dermatopatias Infecciosas/complicações , Pele/patologia , Antitoxina Tetânica/administração & dosagem , Tétano , Parede Abdominal , Desbridamento/métodos , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/prevenção & controle , Feminino , Humanos , Fatores Imunológicos/administração & dosagem , Recém-Nascido , Necrose , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/fisiopatologia , Dermatopatias Infecciosas/terapia , Tétano/diagnóstico , Tétano/etiologia , Tétano/fisiopatologia , Tétano/terapia , Resultado do TratamentoAssuntos
Aniversários e Eventos Especiais , Traumatismos por Explosões/história , Tétano/história , Traumatismos por Explosões/complicações , Traumatismos por Explosões/epidemiologia , Cidades/epidemiologia , Cidades/história , História do Século XX , Humanos , Tétano/etiologia , Tétano/mortalidade , Antitoxina Tetânica/administração & dosagem , Antitoxina Tetânica/história , Trismo/etiologia , Trismo/história , Trismo/mortalidade , Estados Unidos/epidemiologiaAssuntos
Cuidados Críticos/métodos , Traumatismos Cranianos Penetrantes/complicações , Tétano/diagnóstico , Tétano/terapia , Adolescente , Traumatismos Cranianos Penetrantes/terapia , Humanos , Masculino , Tétano/etiologia , Antitoxina Tetânica/administração & dosagem , Antitoxina Tetânica/uso terapêutico , Resultado do TratamentoRESUMO
OBJECTIVE: To study the demographic profile, prognostic indicators, and mortality of tetanus patients and treatment outcomes following intramuscular anti-tetanus immunoglobulin (ATG) alone or combined intrathecal and intramuscular ATG. DESIGN: Retrospective study. SETTING: Inpatients from a tertiary care hospital. SUBJECTS: One hundred children under 12 years of age diagnosed with tetanus and admitted from January 2003 to December 2007 were included in the study. METHODS: Case records of patients with neonatal tetanus (n=30) and post-neonatal tetanus (n=70) were evaluated retrospectively. The diagnosis of tetanus was based on World Health Organization (WHO) criteria. The outcomes of patients treated with either intramuscular ATG or both intrathecal and intramuscular ATG were separately compared in the neonatal and post-neonatal groups. RESULTS: Our study revealed difficulty in feeding, trismus, spasms, rigidity, and opisthotonus posturing as the predominant clinical manifestations. The survival rate for children receiving tetanus immunoglobulin by the dual route was significantly higher than for children receiving the immunoglobulin via the intramuscular route. Seizures and tremors were poor prognostic factors associated with tetanus.
Assuntos
Antitoxina Tetânica/administração & dosagem , Tétano/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Injeções Intramusculares , Injeções Espinhais , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária , Tétano/prevenção & controle , Tétano/terapia , Resultado do TratamentoRESUMO
OBJECTIVE: To estimate the incremental cost of delivering intrathecal tetanus immunoglobulin compared to an intramuscular option. METHODS: To compare the two interventions, costs were estimated using standard cost methodology. Cost categories were personnel, overhead, consumables, antibiotics to treat infection, gases for respiratory assistance and immunoglobulin. Tetanus patients, aged 12 years or older, who were part of a randomised controlled clinical trial conducted in a referral hospital in Recife, Brazil, were allocated to two groups: a control group (58) and a study group (62). Patients allocated to the control group received 3000 international units (IU) of human immunoglobulin, with preservative, intramuscularly. The study group received the same quantity of immunoglobulin also intramuscularly plus an intrathecal dose of 1000 IU of a human immunoglobulin, free of preservatives, to prevent irritation of the meninges and avoid the need for corticosteroids. Thus, the difference between the two groups was the exclusive use of intrathecal immunoglobulin. The outcome measurements were clinical progression, hospital stay, respiratory assistance and respiratory infection. RESULTS: Delivering intrathecal immunoglobulin to patients saved a total of US$ 60 389, in a 10-day intensive care treatment, by preventing a worsening of their tetanus severity (e.g. from Grade I to Grades II, III, IV). Substantial cost saving was also observed in terms of hospital stay (US$ 173 104). CONCLUSIONS: Intrathecal treatment of tetanus is cost saving. This intervention deserves consideration by doctors and decision-makers as a mean of saving resources while maintaining high-quality health outcomes.
Assuntos
Injeções Intramusculares/economia , Injeções Espinhais/economia , Antitoxina Tetânica/economia , Tétano/economia , Adolescente , Criança , Redução de Custos , Custos e Análise de Custo , Quimioterapia Combinada , Humanos , Oxigenoterapia/economia , Índice de Gravidade de Doença , Tétano/tratamento farmacológico , Antitoxina Tetânica/administração & dosagem , Resultado do TratamentoRESUMO
Tetanus is a very serious neuromuscular disease caused by a powerful exotoxin, tetanospasmin, from the Clostridium tetani bacillus. Its incidence in the developed world has diminished considerably since the introduction of primary vaccination. Tetanus is diagnosed clinically, through recognition of the characteristically inducible muscle spasms. Three clinical forms described in adults are generalised, localised and cephalic tetanus. Management of tetanus aims at removing the source of tetanospasmin, neutralising circulating toxin, and providing adequate supportive care for muscle spasms, respiration and autonomic instability. Tetanus is a forgotten disease in developed countries since many practicing primary care physicians have not seen a single case in their career. We present a case of tetanus and review briefly the pathogenesis, clinical features and therapy in order to educate the internist in recognising and adequately treating this disease.
Assuntos
Antibacterianos/administração & dosagem , Emergências , Fatores Imunológicos/administração & dosagem , Antitoxina Tetânica/administração & dosagem , Tétano/diagnóstico , Tétano/terapia , Idoso , Astenia/microbiologia , Feminino , Humanos , Respiração Artificial/métodos , Tétano/microbiologia , Resultado do Tratamento , Trismo/microbiologia , OcidenteRESUMO
A 79 year old farmer was referred to the University Hospital with a three days history of difficulty in opening his mouth. On examination, both masseters were seen to be stiff, suggesting tetanus or jaw-subluxation. An attempt to reduce the joint was made, but failed. He subsequently developed progressive respiratory difficulties requiring intubation. The farmer had recently cut his finger on barbed wire. He had not received tetanus immunization for years and it was not clear whether primary immunization had been completed. Tetanus immunoglobulin and antibiotics were administered. He proceeded to develop autonomic instability and critical illness polyneuropathy requiring 45 days of ICU care. He was finally discharged eight months later. The farmer has gradually improved and is now living unaided at home. In this article we will review this case and the literature on tetanus.
Assuntos
Doenças dos Trabalhadores Agrícolas , Agricultura , Tétano , Idoso , Doenças dos Trabalhadores Agrícolas/diagnóstico , Doenças dos Trabalhadores Agrícolas/etiologia , Doenças dos Trabalhadores Agrícolas/fisiopatologia , Doenças dos Trabalhadores Agrícolas/terapia , Antibacterianos/administração & dosagem , Humanos , Tempo de Internação , Masculino , Recuperação de Função Fisiológica , Tétano/diagnóstico , Tétano/etiologia , Tétano/fisiopatologia , Tétano/terapia , Antitoxina Tetânica/administração & dosagem , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Tetanus remains a major health problem in Ethiopia like in most other developing countries. OBJECTIVES: To assess the clinical presentation, complications and outcome of tetanus patients. METHODS: In this retrospective study, patients (age > 13 years) who were admitted to Jimma University Teaching Hospital from 1996 to 2009 were included. RESULTS: Data from 171 patients were analyzed (129 males, 42 females, mean age 33 years). The mean hospital stay for patients discharged cured and deceased was 21.5 ± 12 and 6.5 ± 6.7 days, respectively. None of our patients was immunized for tetanus. Tracheostomy and mechanical ventilation (MV) was done in 10.5% and 11 %, respectively. The case-fatality was 38%. The mean annual admission and case-fatality increased over the study period from 9 to 20.5 and from 21 % to 51%, respectively. Establishment of intensive care unit (ICU) did not improve mortality due to infrequent tracheostomy and MV. CONCLUSIONS: The case-fatality was high like in most other studies and the majority of patients died in the first few days indicating that adequate respiratory support was not given. Establishment of ICU did not improve mortality. Tetanus can be prevented by vaccination and if it occurs it needs well equipped ICU.
Assuntos
Mortalidade Hospitalar , Tétano/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Etiópia/epidemiologia , Feminino , Hospitais de Ensino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Taxa de Sobrevida , Tétano/classificação , Tétano/diagnóstico , Tétano/terapia , Antitoxina Tetânica/administração & dosagem , Resultado do Tratamento , Adulto JovemAssuntos
Tétano/terapia , Algoritmos , Canadá/epidemiologia , Causas de Morte/tendências , Árvores de Decisões , Jardinagem , Humanos , Esquemas de Imunização , Quebeque/epidemiologia , Fatores de Risco , Gestão da Segurança , Tétano/epidemiologia , Tétano/etiologia , Antitoxina Tetânica/administração & dosagem , Toxoide Tetânico/administração & dosagem , VacinaçãoRESUMO
A 77-year-old man non-immunized to tetanus suffered head trauma on the right side when he tumbled from a height of approximately 2m. Five days later, he experienced difficulty in opening his mouth and developed right ptosis. He was referred to our hospital 2 days post-ictus. The patient suffered trismus, and developed right Horner's syndrome with in a week. Symptoms due to multiple cranial nerve palsies were observed: right inferior oblique muscle weakness, reduced right corneal reflex, right facial palsy, dysphagia, and abnormal tongue movements. Neuroimages (computed tomography, magnetic resonance imaging, and angiography) of the basal skull and internal carotid arteries revealed no abnormalities. From the symptoms associated with his infected head wound and clinical follow-up, we suggested that he had cephalic tetanus. We subsequently conducted the following treatments: debridement of the wound, intravenous infusion of antitetanus human immunoglobulin (AHI), intrathecal AHI infusion, and systemic administration of benzylpenicillin. His condition improved with these treatments, and without any complications such as autonomic nervous system dysfunction or classical tetanic spasms. This case suggests that we should consider the possibility of cephalic tetanus when we observe a patient with cranial nerve palsy associated with injury.
Assuntos
Doenças dos Nervos Cranianos/etiologia , Traumatismos Cranianos Fechados/complicações , Tétano/etiologia , Acidentes por Quedas , Idoso , Antibacterianos/administração & dosagem , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/terapia , Desbridamento , Síndrome de Horner/diagnóstico , Síndrome de Horner/etiologia , Síndrome de Horner/terapia , Humanos , Masculino , Penicilina G/administração & dosagem , Tétano/diagnóstico , Tétano/terapia , Antitoxina Tetânica/administração & dosagem , Resultado do TratamentoRESUMO
Antirabies service activities of the Infectious Diseases Prophylaxis Centre of the Sapienza University of Rome during the period 2005-2007. Authors analyzed data, of antirabies activity, from 3206 patients treated at the Infectious Diseases Prophylaxis Centre of the University of Rome "La Sapienza" during the period 2005-2007 Dogs were responsible for most bites (92.1%). All patients went first to the Emergency Room where tetanus prophylaxis was administrated only with specific immunoglobulins (51.5%): to such patients we suggested to implement prophylaxis with vaccination. For other patients (19.4%) we prescribed only vaccine tetanus prophylaxis. Antirabies vaccine (PCEC) has been injected in 604 patients (18.8%). Rabies immunoglobulins have been prescribed only to 11 (0.4%) patients that were bitten during travel to Asia or Africa (0.4%). The authors emphasize the opportunity to reduce the administration of anti-tetanus immunoglobulin in Emergency Room by a deeper evaluation of patient's immunity; moreover the authors confirm a clear quantitative reduction of prophylactic interventions against rabies in Italy.
Assuntos
Centros Médicos Acadêmicos , Mordeduras e Picadas/terapia , Tratamento de Emergência , Serviços Preventivos de Saúde/estatística & dados numéricos , Vacina Antirrábica/administração & dosagem , Raiva/prevenção & controle , Adulto , Animais , Quimioterapia Combinada , Feminino , Humanos , Imunoglobulinas/administração & dosagem , Fatores Imunológicos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cidade de Roma/epidemiologia , Tétano/prevenção & controle , Antitoxina Tetânica/administração & dosagemRESUMO
PURPOSE: Few anesthesiologists have expertise in the diagnosis and treatment of tetanus, a disease that remains prevalent in developing countries. We report on a series of four cases of tetanus cases recently encountered in Rwanda. We review the clinical epidemiology, pathophysiology, diagnosis and the treatment of tetanus, and provide implications for anesthesiologists and critical care physicians. CLINICAL FEATURES: We report four cases, two involving adults who were inadequately vaccinated and experienced injuries, and two involving neonates, both of whom underwent umbilical cord transection using unsterilized equipment. All patients required tracheal intubation, and were mechanically ventilated when equipment was available. One adult and one neonate succumbed to the disease. These cases highlight the difficulties of diagnosis and management of complicated diseases in the resource-challenged health care setting of developing countries. CONCLUSIONS: The differential diagnosis of tetanus may be confusing, and survival depends on the rapidity of treatment with antitoxin, as well as adequate supportive care. High doses of sedatives and muscle relaxants, as well as prolonged mechanical ventilation, are usually necessary. Mortality remains high, usually resulting from late respiratory failure and cardiovascular collapse, associated with autonomic instability. Anesthesiologists and critical care physicians have an important role to play in the management of these patients. Increased involvement in humanitarian health organizations, immigration from developing countries, and emergence of high risk groups in developed countries will likely result in more exposure of anesthesiologists to the complexities of this disease.
Assuntos
Antitoxina Tetânica/administração & dosagem , Toxoide Tetânico/administração & dosagem , Tétano/terapia , Adulto , Cuidados Críticos/métodos , Países em Desenvolvimento , Diagnóstico Diferencial , Evolução Fatal , Humanos , Lactente , Recém-Nascido , Intubação Intratraqueal , Masculino , Respiração Artificial , Tétano/diagnóstico , Tétano/mortalidade , Tétano/fisiopatologiaRESUMO
OBJETIVO: Determinar, em cobaias prenhes e em gestantes, a produção de antitoxina tetânica induzida pela aplicação da anatoxina tetânica e estudar a sua passagem para o recém-nascido. MÉTODOS: Na primeira fase, em estudo experimental, cobaias prenhes foram vacinadas com duas doses de toxóide tetânico em um intervalo de 15 dias, seguida da dosagem de anticorpos na cobaia imunizada, na prole ao nascer e 15 dias após o nascimento. Outro grupo de animais previamente vacinado recebeu uma dose de reforço 30 dias antes do parto, medindo-se o nível de anticorpos na cobaia e na prole. Na segunda fase, em ensaio clínico, as gestantes humanas foram vacinadas com três injeções de anatoxina tetânica, com um intervalo de 30 dias, em qualquer período da gravidez, medindo-se, a seguir, a antitoxina tetânica. Nos recém-nascidos, os anticorpos foram medidos ao nascer e aos 15 dias de vida. RESULTADOS: O título de antitoxina no sangue da prole de cobaias vacinadas com anatoxina tetânica foi elevado ao nascimento e aos 15 dias de vida. A dose de reforço provocou elevação do título basal. Nas gestantes, a aplicação de três doses de toxóide antitetânico conferiu imunidade a 95% dos recém-nascidos estudados. Os recém-nascidos de mães vacinadas apresentaram títulos elevados de antitoxina que persistiram por mais de 15 dias de vida. CONCLUSÕES: A vacinação durante a gestação foi acompanhada de títulos protetores de antitoxina contra o tétano tanto nos filhotes de cobaias quanto nos recém-nascidos humanos.
OBJECTIVE: To measure, in pregnant guinea pigs and women, the production of tetanus antitoxin, induced by vaccination with tetanus toxin, and to study the transmission of these antibodies to the offspring. METHODS: In an experimental design, pregnant guinea pigs were vaccinated with two doses of tetanus toxoid with a 15-day interval followed by determination of antibodies in the immunized guinea pig, in the offspring at birth and after 15 days of life. One group of guinea pigs received a booster dose of tetanus toxoid 30 days before delivery and the immunization status of dam and offspring was also studied. In a clinical trial, pregnant women were vaccinated in any period of gestation with three doses of tetanus toxoid with a 30-day interval; the antibody levels were measured in the mother and in the newborn infant at birth and at the 15th day of life. RESULTS: The antibody levels of guinea pigs offspring immunized with tetanus toxoid during gestation were elevated at birth and at the 15th day of life. These levels were elevated by the booster dose 30 days prior to delivery. In pregnant women, the immunization with three doses of tetanus toxoid was followed by immunity in 95% of the studied infants studied. The newborn infants of vaccinated women presented elevated levels of antibodies at birth and at 15th day of life. CONCLUSIONS: Vaccination during gestation was followed by protective levels of antibodies in guinea pigs and in newborn infants.
Assuntos
Humanos , Animais , Gravidez , Recém-Nascido , Cobaias , Antitoxina Tetânica/administração & dosagem , Toxoide Tetânico , Tétano/prevenção & controle , VacinaçãoRESUMO
The aim of this paper is to address the management of tetanus-prone wounds and the use of tetanus prophylaxis within the remit of the emergency nurse practitioner (ENP) to ensure safe and effective management of patients who present to the Emergency Department (ED) with tetanus-prone wounds. The paper will also provide the reader with an overview of the epidemiology of tetanus along with the signs and symptoms of tetanus. Practicalities of tetanus vaccine storage and injection will also be discussed. The paper will also discuss Protetanus which is a single step immunoassay for the determination of anti-tetanus immune status; this product has the potential to reduce over immunisation with tetanus and can provide the clinician with a tetanus antibody status in patients who are unaware of their own immunisation status.
Assuntos
Enfermagem em Emergência , Profissionais de Enfermagem , Antitoxina Tetânica/administração & dosagem , Tétano/prevenção & controle , Ferimentos e Lesões/enfermagem , Humanos , Avaliação em Enfermagem , Tétano/epidemiologia , Tétano/imunologia , Reino Unido/epidemiologia , Estados Unidos/epidemiologia , Ferimentos e Lesões/microbiologiaRESUMO
Electrocardiographic and echocardiographic parameters were studied in 364 patients admitted to the department of thoracic surgery of Bashkirian Medical University clinic in 1997-2006. The patients had hemorrhagic shock due to acute traumatic blood loss or long operative intervention with massive hemorrhage. It was found that preliminary vaccination with tetanus antitoxin improves a course of posthemorrhagic period, hemodynamic restoration and survival of the patients.