Jawab dengan Cepat

1. Kertas HVS warnanya apa ?

2. Awan warnanya apa ?

3. Tissue warnanya apa ?

4. Sapi minumnya apa ?

Test ulang ...... Jawab dgn cepat

1. Rambut anda warnanya apa ?

2. Alis warnanya apa ?

3. Aspal warnanya apa ?

4. Kelelawar tidurnya kapan ?

Tetanus
Treatment : Focusing On Tetanus Human Immunoglobulin

F Siusanto Hadi, SpBKBD

Tetanus (from Ancient Greek: τέτανος tetanos “taut”,
and τείνειν teinein "to stretch") is a medical condition
characterized by a prolonged contraction of skeletal muscle
fibers, caused by tetanospasmin, a neurotoxin produced by
bacterium Clostridium tetani.
The organism is Aetiology :
sensitive to heat Clostridium tetani
Obligate an-aerobic,gram +,
and cannot survive spore forming bacillus
in the presence of
oxygen.
The spores, in contrast, are very
resistant to heat and the usual
antiseptics. They can survive
autoclaving at 249.8°F (121°C)
for 10–15 minutes. The spores
are also relatively resistant to
phenol and other chemical
agents.
The spores can also be found on skin
surfaces and in contaminated heroin.
The spores are widely
distributed in soil and
in the intestines and
feces of horses, sheep,
cattle, dogs, cats, rats,
guinea pigs, and
chickens.
Manure-treated soil
may contain large
numbers of spores.
In agricultural areas, a
significant number of
human adults may
harbor the organism.
Tetanus toxin is highly potent; a lethal dose is estimated to be 2.5
ng/kg body weight (1 g of toxin corresponds to the lethal dose for
6,000,000 adults weighing 60 kg)
What’s happen ?
The toxin travels via intra axonal transport
at rate 75-250 mm/day
It takes 2-14 days to reach CNS

Retrograde transport
In Normal Condition …….
In Tetanus Condition …….
TREATMENT
The define goals of
treatment include the
following :
1. Halting production of toxin
within the wound
(eradication source)
2. Neutralization of unbound
toxin
3. Control muscle spasm
4. Treatment of autonomic
instability
5. Supportive therapy
6. Management of
complications
Halting production of toxin
within the wound
Debride the wound

&
Removing of all necrotic tissue & foreign
material from the wound > good media
for bacterial growth
Antimicrobial Drugs
Source eradication : Most Important

Wound management
– Eradicate vegetative & Spores , and change
condition for germination thereby preventing
elaboration & absorption neurotoxin
– Good Debridement
Too tight, leave it
open
Source eradication
 Bacterial biofilm

D E
R I
EB
D
More than once
Neutralization Unbound Toxin
This achieved through PASSIVE
IMMUNISATION that should be
undertaken as early as possible since
the toxin became once its bound to
nerve terminus
 Passive Immunisation

Human Tetanus Immunoglobulin

Tetanus immunoglobulin is a solution that contains antibodies which provides
immediate protection against tetanus.
Human Tetanus Immunoglobulin

•Human Immunoglobulin
•No Preservatives
•Skin test Not Necessary
•Risk Allergy : Not Reported ("anti complementary aggregates of globulin)
•About 4 weeks protection, fetal protection
•7 unit Ig/IU
•Prophylaxis Dosage : 250 IU (IM)
•Therapeutic Dosage : 3000-6000 IU in IM one shot
•Expired date : 36 months
•Relative High Price, widely distribution, repeated doses
Anti Tetanus Serum
•C/I : History of Hypersentivity to Ig

•Equine serum
•Preservatives Phenol 0,25%
•Skin test Necessary
•Risk Allergy : Reported Anaphylaxis 1/10.0000
•About 1 weeks protection, No fetal protection
•1 unit Ig/IU
•Prophylaxis Dosage : 1500 IU (IM)
•Therapeutic Dosage : 100.000 IU -200.000 divided in IM & IV
•Expired date : 24 months
•Cheap price, available, not possible repeated doses
•C/I : History of Anaphylaxis / drugs allergy
HOW DOES IMMUNOGLOBULIN WORKS ?

Ig
For treatment: The dose of tetanus
immunoglobulin for intravenous use is
5000–10,000 IU by infusion (depend on the
country).

If intravenous administration is not possible,

150 IU/kg of the intramuscular preparation may
Frequency of administration
Single dose
Adverse outcomes/ side effects
• Short term discomfort at the injection site
• Rarely anaphylactic reactions
• Occasionally: fever, chills
• Rarely: nausea, vomiting, hypotension, tachycardia, allergic
reactions
Reporting of adverse reactions
• Any serious adverse reaction to the immunoglobulin
should be documented in the patients notes.
Can you get tetanus more than once?
Yes! Tetanus disease does not result in immunity
because so little of the potent toxin is required to cause the
disease. People recovering from tetanus should begin or
complete the vaccination series.
Current guidelines suggest that wounds that are oxygen deficient are tetanus
prone, as C. tetani is an obligate anaerobe. Thus, wounds that have been crushed,
devitalized, or contaminated with dirt or rust are believed to be more prone to tetanus.
Wounds such as open fractures, punctures, and abscesses are also thought to
be more tetanus prone.
The dose of tetanus immunoglobulin for prophylaxis is 250
IU (1 ml) intramuscularly into the anterolateral thigh.

This dose is doubled to 500 IU (2ml) when any of the

following situations exist:

• The injury occurred > 24 hours previously.

• The patient weighs > 90 kg.
• The wound is heavily contaminated.
• The wound is infected or involves a fracture.

Prophylaxis Dosage
Managemet Protocol for
Tetanus
Conclusion
1. Tetanus still exist
2. Diagnosis based on Clinical presentation
3. Treatment : Source eradication &
Supportive treatment
4. Most important : Good Debridement
5. Human Tetanus Immunoglobulin may used
for Treatment & wound prophylaxis.
6. Prevention is the best
THANK YOU