Prophylaxis:
(1) Routine active immunization by 3 injections of 1 cc of toxoid to susceptable individiuals.
(2) Booster dose for patients. whome are actively immunized within the previous 10 years.
(3) Passive immunization by antitetanic serum . 3000 I.U. are given I.M. after sensitivity tests.
(4) Antitetanic human globulin 200 U are given I.M.
Treatment:
1- Care of respiration . 2- Nursing care.
3- Control of spasms. 4- Control of hyperthermia.
5- Antitoxic and antibiotic therapy. 6- Care of the wound.
1- Care of respiration :
a- Continuos suction .
b- Antibiotics to avoid hypostatic pneumonia .
c-Tracheostomy to
Diminish dead space Facilitate suction. Allow positive pressure ventillation (PPV), if needed.
2- Nursing care:
a- Keep the patient in dark quiet room to avoid stimulation.
b- Nourishment through Ryle tube .
c- Urinary catheterization and daily enema.

3- Control of spasm:
a- Mild cases ® Barbiturates .
b- Moderate cases ® Largactil and barbiturate .
c- Severe cases ®curare (Tracheostomy is needed )
4- Control of hyperthermia
a- Cold compresses .
b- Ventilation.
c- Largactil.
5- Antibiotic and antitoxin therapy :
a- Penicillin should be given in large dose as the organism is sensitive to it .
b- Antitoxic serum in big dose to neutralize the circulating toxins ( toxins fixed to A.H.C cann't be neutralized). We give 200,000 units I.V. then 50,000 units are given again after one week.
6- Care of the wound : (Always after antitoxin and antibiotic therapy )
a- Wound excision or drainage.
b- Irrigation by H2O2.

F Important Definitions
u Necrosis = Death of the tissues
u Gangrene = Death and putrifaction of tissues which may be:
Ä Dry gangrene: Putrifaction in dry tissues as in cases of chronic ischemia of the tissues.
Ä Wet gangrene: In cases of putrifaction in wet tissues as in cases of intestinal gangrene or gangrene in acute ischmia.
Ä Infective gangrene: Necrosis and putrefaction of tissues occur due to infection.

SOURCE: DR. AYMAN SALEM'S BOOK
Copyright: Vascular Society of Egypt (www.vsegypt.org) &Medical Educational web (Medical Educational web)
Not to be reproduced without permission of Vascular Society of Egypt