Tetanus and botulism, symptoms, first emergency first aid for tetanus and botulism.

Tetanus is an infectious disease characterized by toxic damage to the nervous system by poison, which is produced by tetanus bacteria. Tetanus is usually accompanied by convulsions.. 

Tetanus and botulism, infectious diseases, first emergency first aid for tetanus and botulism.

The causative agent of tetanus is a bacterium that enters the soil with feces of various animals, turns into spores and can exist in this form for many years. Human infection occurs when bacteria enter the body through damaged skin (with a variety of abrasions, scratches and wounds).

Less commonly, tetanus infection occurs during criminal abortions, as well as during military operations, when a bullet or fragment penetrates the body through contaminated clothing. Tetanus is distributed mainly in rural subtropical and tropical climatic zones.

Symptoms of tetanus.

Tetanus has an incubation period of 6-14 to 30 days, after which the clinical signs of the disease develop. In some cases, the infected person has precursors of the disease, manifested in the form of pulling pains in the wound area – the entrance gate of the infection, as well as convulsive twitches of nearby muscles. Sometimes a tetanus bacterial infection of the umbilical cord in a child is possible; in this case we are talking about neonatal tetanus. The first clinical manifestations of tetanus are convulsive contractions of the masticatory muscles – difficulties (sometimes impossibility) in opening the mouth.

At the same time, the patient’s mouth is pathologically stretched (the impression of a smile is created), the eyebrows are raised, and characteristic wrinkles appear on the frontal area of ​​the face (in young people they do not correspond to age). With the most severe manifestations of tetanus, the patient’s head is thrown back, and the body rests on the bed exclusively on the occipital part of the head and heels. The patient has difficulty or complete inability to swallow due to tension of the swallowing muscles; muscles of the chest, back and diaphragm are also very tight.

Within 1–5 days from the appearance of pronounced symptoms of tetanus, general twitching convulsions develop, which last from a few seconds (may go unnoticed) to 3 minutes. The patient is characterized by increased sweating, which intensifies during convulsive attacks, tonus of skeletal muscles and sphincters. Minimal external irritation (sharp noise, light, etc.) can cause a convulsive attack. A patient with tetanus is not contagious and does not pose a danger to others.

The most common tetanus complications are skeletal muscle ruptures and sepsis. Timely and adequate treatment can save the lives of many patients, although with this disease the prognosis is generally unfavorable. The highest mortality rate, according to statistics, is observed in criminal abortions and domestic management of childbirth. With timely and successful treatment, tetanus lasts 2–4 weeks.

First aid for tetanus.

If the patient has tetanus, then he needs complete rest (darkened room, lack of noise, etc.). During seizures, it must be held to prevent injuries. To avoid biting the tongue between the teeth, lay a towel assembly. A patient with suspected tetanus is immediately hospitalized in a medical institution in which there is an intensive care unit; in addition to treating the wound, intramuscular administration of 100,000-150,000 IU of tetanus tetanus or 900 IU of specific globulin is required. An active immunization with a tetanus toxoid dose of 0.5 ml is also carried out. (2-3 injections, the interval between them should be 3-5 days).

The fight against seizures is carried out through the use of antipsychotics and other anticonvulsants. In most cases, the patient needs treatment for respiratory failure, including the transfer to mechanical ventilation. Tetanus prophylaxis consists in immediately contacting a doctor for any abrasions and scratches (even conditionally contaminated with soil). The physician is required to perform surgical treatment of the wound and administer tetanus toxoid, tetanus toxoid, or immunoglobulin. Primary tetanus prophylaxis boils down to routine tetanus toxoid vaccinations.

Botulism.

Botulism is a foodborne toxicosis that occurs as a result of eating poor-quality foods. This disease is characterized by muscle paralysis. The disease develops after eating foods that contain toxins produced by botulinum bacteria. These bacteria (sticks) are quite widespread in nature and live in the environment in the form of spores, which are very resistant to external influences the existence of bacteria.

Getting on food or in the intestines of some animals (in particular, fish), spores germinate in a vegetative form and begin to produce a toxin. A necessary prerequisite for the transition of botulinum rods to a life-threatening form is the absence of oxygen (anaerobic conditions). The last fact is related to the fact that poisoning occurs more often in canned food, i.e. products that are in airtight containers. Poisoning with ham or smoked fish is also not uncommon if they have not gone through enough heat to kill microorganisms..

Cans or lids of glass jars of poor-quality canned goods are typically swollen due to the accumulation of a large amount of gas in them during the active activity of bacteria. When contaminated products enter the human digestive system, toxins in the intestine are absorbed very quickly, which leads to damage to a number of systems and organs – primarily the nervous system.

Symptoms of Botulism.

The first clinical symptoms of the disease begin to appear suddenly, a few hours after eating foods containing botulinum toxin toxin. The patient has a headache, dizziness, a feeling of weakness, sleep disturbance (insomnia), pain in the abdomen, nausea, repeated vomiting, a feeling of fading of the heart, as well as thirst and dry mouth. Often constipation and bloating appear. After a few hours or 1-2 days, visual impairment is noted. Usually patients complain of fog and flickering flies before their eyes. The outlines of objects lose their distinctiveness, often double vision occurs.

Pupils are almost 100% dilated, eyelid drooping may occur. Around the same period of the development of the disease (or a little later), swallowing disorder joins. The patient complains of pain during the act of swallowing or a sensation of a lump in the throat. Speech is becoming less and less legible, the voice becomes nasal, a complete aphony (the inability to pronounce sounds) may develop.

Significant respiratory distress is also likely, in which the patient complains of a lack of air, a feeling of tightness or constriction in the chest area. The patient’s body temperature may be slightly elevated or remain within normal values. The general condition of a person who has undergone botulism is restored quite slowly; visual impairment associated with poisoning can persist after the complete disappearance of other clinical signs of the disease.

First aid for botulism.

When the first signs of this foodborne toxicoinfection appear, a person should be urgently hospitalized; the likelihood of his life being saved is the higher, the faster the anti-botulinum serum is introduced. A small amount of food debris or vomit should be stored for examination and confirmation of a possible diagnosis. The patient undergoes gastric lavage using a 2% solution of sodium bicarbonate, do a cleansing or siphon enema, and a laxative is prescribed (in this case, 30 g of magnesium sulfate in 500 ml of water).

These measures are aimed at maximally cleansing the gastrointestinal tract from food debris containing botulinum toxin and preventing its further absorption. If swallowing is impaired, then gastric lavage is done with a rubber probe. Anti-botulinum sera are types A, B, C and E. If the type of toxin is not known, then the patient is immediately injected with type A serum at a dosage of 10,000 15,000 IU, type B – 5,000–7,500 IU, and type E – 15,000 IU. Before intravenous administration, the anti-botulinum serum is heated to 37 degrees. It should be remembered that it is first necessary to put an intradermal test for the detection of an allergic reaction using serum at a dilution of 1: 100.

In especially severe forms of botulism, serum is required to be administered an additional 1-2 times, observing an interval of 6-8 hours. The patient is also prescribed subcutaneous or intravenous administration of 5% glucose solution, isotonic sodium chloride solution with a total volume of up to 1000 ml. and diuretics. In the event that as a result of paralytic closure of the upper respiratory tract signs of suffocation increase, a tracheostomy is indicated. In case of paralysis of the respiratory muscles and severe respiratory failure, the patient must be transferred to artificial lung ventilation.

Even with timely and adequate therapy in a specialized hospital, mortality in botulism is high – 15-30%. Therefore, lovers of homemade canned food should be careful: follow the technological rules for their preparation and storage. In no case should you use canned food from bomb containers.

It should be noted that people who used suspicious canned food along with the patient should, for prophylaxis, administer each of the three types of anti-botulinum vaccine of 1000–2000 IU and observe them for 10–12 weeks. Be sure to warn people who could have been poisoned that folk remedies for disinfection drinking alcohol are strictly contraindicated, and in the case of the development of the disease can significantly aggravate its course.

Based on Quick Help in Emergencies.
Kashin S.P..

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