LOCKJAW CAUSES LOCKJAW SYMPTOMS (TETANUS) LOCKJAW TREATMENT / TETANUS TREATMENT
Lockjaw causes: Lockjaw (tetanus) is an acute infectious disease caused by a bacillus called Clostrodium tetani characterized by intermittent tonic spasm of voluntary muscles and convulsion(Lockjaw symptoms).
Incubation period: 2days to 5weeks or longer than average of 5-100 days
Tetanus is caused by an exotoxin produced by the bacteria - Clostrodium tetani (lockjaw causes -the causative organism) which is a slender rod-shaped gram-positive anaerobic spore-forming organism. Each spore remains viable for several years. The spores can be found in the soil, dust, animal and human feaces. Tetanus can follow contamination of wound such as those made by nails favours the organism. Tetanus neonatarum may follow the use of contaminated instruments for severing the cord at birth or in circumcision. The incidence is greater among women low income group not receiving immunization and among women and elderly who may have not been immunized as children or have lost their immunization. It is a worldwide disease which is characterized by several symptoms(e.g. lockjaw symptoms).
PATHOPHYSIOLOGY (PHYSIOLOGY OF ABNORMAL STATE)
Clostrodium tetani produces/produces three exotoxin, each has where it affects in the body namely;
- Non convulsive Neurotoxin
(a)Tetanus-spasm in which is neurotoxin which have special affinity for nervous tissues especially the spinal cord and cranial nerves where they produce a reaction resultive in stimulation of the nervous tissue. There is intensive and severe muscle spasm (a sudden uncontrolled and often painful tightening of the muscle). The other exotoxins are (b)non convulsive neurotoxins and (c) tetanolysin which may have haemolytic and cardio-toxic effect. These neurotoxins are absorbed by the peripheral nerves to the nervous tissue. The sensory nerves becomes sensitive to the slightest stimuli and the hypersensitive motor nerves carry impulses that stimulate the muscle until they supply. The spasm produce rapidly involve other group of muscle until the whole body is affected. The spasm is continuous but sudden stimulus such as bad noise or banging a door may cause generalized convulsion. There may be fracture of the vertebra during severe spasms. Opisthonous occur, the toxins can no longer be neutralized by antitoxin once it is fixed to nerve cells. Death may occur from asphyxia due to spasm of respiratory muscle or from pneumonia.
The early lockjaw symptoms includes the following irritability, restlessness, headache, low grade fever and muscle rigidity including those of the jaw making it difficult for the patient to open his mouth because of painless spasm of the masseter (trismus) it is from this characteristic symptoms that it came to be called "Lockjaw" (Lockjaw symptoms), the spasm of the facial muscle produce a characteristic distorted smile referred to as risus saddonius . The spasm which may persist even during convalescence. Other features include fleeting back ache difficulty in swallowing which increase as the disease progress, rigidity of the muscle produce head retraction and opisthotonus, ultration of voice ducts, clenched teeth, convulsion, minor twisting of individual, isolated part may occur, laryngeal spasm and abdominal rigidity may also occur.
DIAGNOSIS (LOCKJAW CAUSES)
Lockjaw can be used to describe tetanus, it is a serious infection caused by the bacteria (Clostrodium tetani), it causes stiffness of the jaw and neck. It gradually progresses to other body parts, it can be fatal when left untreated. One of the early symptoms of lockjaw disorder is stiffness in the jaw. This particular condition is serious and requires immediate treatment
STEPS IN DIAGNOSIS OF LOCKJAW SYMPTOMS
- Clinical Examination: The pressure of trismus painless abdnigidity and fever with hypersensitivity in a patient strongly suggests tetanus
- History of previous wound in a patient with muscle stiffness or spasm is also suggestive of tetanus
- Culture of wound exudate may the presence of the organism
Meningitis, Poliomyelitis, Mumps and Strychnine poisoning, Dental abscess
LOCKJAW TREATMENT (MANAGEMENT)
General consideration is observed for both established and un-established cases. The management is based on early and adequate neutralization of free toxins circulating in the body
- Prevention of further toxin's production
- Control of muscle spasm hypertoxicity and inter infection
- Maintenance of clear airway, fluid balanc, adequate nutrition
- Tracheostomy(the surgical formation of an opening into the trachea through the neck especially to allow the passage of air) maybe necessary in case of respiratory impairment
- Intravenous (IV) fluid with canular to help keep vein open, needle is easily dislodged and should not be used
- Catherization for urinary retention
- Naso gastric intubation for feeding
- 5% dextrose is administered to neutralize the toxin in the patient
- Cleansing enema may be given for constipation with adequate precaution as the faecal matter may contain the organism
- Wound care including wound debridment or excision
- Adequate nursing care
TETANUS TREATMENT (DRUG THERAPY)
- Once the disease is established , give Human Tetanus Immune Globin (HTIG) to the patient, it neutralizes the toxin. Give 500 units Intramuscular (IM) dose as a start dose, then administer dose of 500-1000 units up to a total of 3,000 - 6,000 units subsequently
- Anti Tetanus Serum (ATS) 50,000 units is administered to the patient 30 minutes after test dose is followed in an hour's time by IV dose of 50,000 units if the patient did not react to the IM dose. The wound can also be infiltrated with anti-toxin.
- Penicillin G can also be given as an antibiotics for tetanus treatment
CAUTIONS (HOW TO UNLOCK LOCKJAW)
HOW TO UNLOCK LOCKJAW
There is high risk of serum sickness with A.T.S
Antibiotic Therapy: Large dose of Penicillin G. either by intramuscularly(IM) or intravenously(IV) to eradicate the persisting organism stop producing or production of new toxins and destroy other organism from the wound, Example: Injection-Chrystapen 1 mega unit twice daily for five to seven -days. Erythromycin may also be used.
Sedation: A combination of chlopromazine 50 mg, phenobarbitone 100mg (IM) 4-8hourly is very helpful. Diazepam and paraldehyde are useful. Tubocoramine and 15mg in (hyalase). Hyalironidase (IM) will prevent contraction to lessen muscle rigidity
NURSING CARE (LOCKJAW TREATMENT)
The following treatment measures should be carefully carried out by the nurse or medical personnel to ensure wholesome Lockjaw treatment (how to unlock lockjaw)
- The patient is nursed in a dark quiet room or corner of the room or ward with minimum disturbances.
- Observe Isolation technique
- Maintain adequate fluid balance and nutrition as well as clear airway
- The nurse or medical personnel should provide emotional support for the patient and family
- Use water which is capable of releasing oxygen into the deep wound
- Administer and observe the effect of prescribed drug
- Monitor vital signs and maintain a chart for convulsion
- Health education of the patient and relatives
- Monitor bowel and bladder functions
- Control abdominal distension by passing flatus tube
- Care of any tracheostomy
- Administer humidified oxygen to control cyanosis
- Discuss follow up care with the patient and family
PREVENTION AND CONTROL
Immunization with TetanusToxoid provides active reduced risk of infection in infants. That of the infant is incorporated in the DPT immunization schedule. A reinforcing dose is given at 18months and a booster dose at 5 years before the child enters school.
The non immunized adult at risk should receive 1st dose of 0.5mls Tetanus toxoid either through subcutaneous or IM followed by a 2nd dose in 6weeks time from the 2nd dose. Passive immunity achieved by ATS may cause hyper sensitivity. Other control measures includes adequate wound care and penicillin prophylaxis approach if injury occurs so as to prevent lockjaw symptoms.
Health education of the public is necessary during the pre-natal and post natal periods.
Pneumonia, Myocarditis (inflammation of the middle muscular layer of the heart), Vertebral fracture, Respiratory failure, Asphyxia, Laryngeal spasm, retention of urine, constipation, Serum sickness, Urticaria, acidosis(abnormal condition which involves reduced alkalinity of the blood and of the body tissues), Cardio-respiratory arrythmias, Dysphasia ( deficiency in the power to use or understand language as a result of injury to or disease of the brain.
High mortality rates are associated with short incubation period. The use of muscle relaxant and artificial respirators have greatly changed the disease picture for better prompt diagnosis and adequate tetanus treatment is associated with good prognosis. Mortality rate is highest in the very young or old people.