The South Korean suspense film "Memories of Killing", which is based on a real case, has recently become a fire because of the arrest of the suspect.
There is a plot in the movie: the leading policeman Song Kanghao's men were smashed on the calf by a wooden stick with nails picked up by the suspect, which was thought to be a trivial matter, who knew that the calf was punctured by a nail, infected with tetanus, the doctor said that it was too late to send it, and the only thing he wanted to save his life was amputation.
GIF Source: Movie "Memories of Killing"
Tetanus, as the name suggests, is really "broken", with a high case fatality rate, still as high as 30% to 50% worldwide [1]! Just like when you say broken mobile phone, broken computer... In the news report, they open like this:
And just recently, a 53-year-old man in Zhuhai, Xie Mou, scratched his toe because of the upper edge of the slippers, and there was a deep opening, which was not noticed at the time, but only eliminated the poison in the clinic. Unexpectedly, after 4 days, he had symptoms such as closed teeth and neck and waist pain, and went to the hospital the next day to develop symptoms of general spasm and coma, and was sent to the ICU for rescue. The culprit was the severe tetanus infection caused by the slipper scratch.
Death, ICU rescue, amputation... These words are frequently associated with "tetanus", and if you infect it, you can't cure it? How to judge whether the wound is risky? Before you get started, let's take a look at where such a ferocious germ comes from.
Tetanus as an infectious disease, the pathogen is its "core soul", and the soul of tetanus, is Clostridium tetanus! This "big poison king", you may meet it every day:
Among the rusted iron tools, it is most common in the soil. Because of its strong spore resistance, it can live in the soil for ten years, especially in fertilized soil and putrid mud. It is also hidden in the human intestine and can be excreted with feces, so even if it reaches Mars, it cannot be shaken off.
It can be said that it is widely distributed in nature in a spore state, and the anaerobic environment is the "hotbed" for their main survival.
Of course, this widely existing bacteria in nature will not cause infection casually, otherwise there will be so many bacteria and viruses around us, and human beings will be "annihilated" in minutes. But this kind of non-invasive bacteria, as long as you give it a chance, its aggressiveness will be awakened:
Generally, when these 3 "Dragon Balls" are collected (one is indispensable), a "Poison King" will be summoned:
There is tissue opening injury with deep wounds
It is invaded by Clostridium tetanus from the outside world
There is inactivated tissue or local tissue ischemia and hypoxia in the wound
Image source: Stand Cool Helo
Take the plot in "Memories of Killing", Song Kanghao's legs were punctured by rusty nails (satisfying condition one), and the nails were rusty, with Clostridium tetanus (meeting condition two), the nails were longer, the wounds were deeper, the natural oxygen was less, and the wound was closed to form an oxygen-deficient environment (satisfying condition three).
In the case of meeting these three conditions at the same time, the spores of Clostridium tetanus will immediately develop into a proliferation, and will begin to produce "poison" when it ruptures - releasing "spasmodic toxins", entering the spinal cord, brainstem, etc., the release of inhibitory mediators is reduced, motor neurons are not inhibited and excitatory, simply put, the following signs of poisoning will appear.
1. Muscle rigidity contractions and intermittent severe spasms
The muscle performance of different parts is different: in the neck, it is the neck rigidity; in the face, it is a bitter smile, the mouth cannot be opened; in the abdominal muscles, it is the plate abdomen; in the dorsal muscles, it is the angle arch reversal.
In a word: muscles are not their own muscles anymore!
2. Autonomic disorders
Presents with unstable hypertension, tachycardia, arrhythmia, peripheral vasoconstriction, sweating, and fever.
Some people describe that if the pain of a child is 10 points, then the pain of tetanus spasms is 10 + N points of pain, and it is not piercing! But don't be too afraid, although you can see the figure of Clostridium tetanus everywhere in life, but as mentioned above, you also need to collect three "Dragon Balls" to gather the poison king.
So, in life, what kind of wounds may cause infection?
In fact, in terms of probability, as long as there is a breach, there is a possibility of contracting tetanus! Of course, the probability of this possibility is not the same.
For example, it is well known that he was punctured by a large rusty iron nail, his head was hit by a large pit by glass, and he was bitten by animals (cats, dogs and other animals are also carriers of Clostridium tetanus), which are all high-risk exposure factors for tetanus. This is especially true if the wound is deep and contaminated with dust or foreign matter.
However, there are also some low-risk ones, such as picking teeth and bleeding, pulling out blood out of the ears, and being stung by a horse bee.
Does not have an obvious wound that could also lead to tetanus?
yes! For example, many people are not familiar with it: the body has a puncture, and diseases such as otitis media, sinusitis, and abscesses can also lead to tetanus [2]!
Speaking of which, you should understand: you can never be sure which wound will attract tetanus bacteria! Although the probability is high and low, there is a possibility of infection, and what we have to do is to reduce this probability to 0 and strangle it in the cradle, after all, we can't afford to take this risk.
If tetanus develops within 2 to 3 days after injury, if treatment is not timely, the case fatality rate of the elderly or infants is even close to 100%. However, with aggressive treatment intervention, 80% to 90% of patients will be cured. And it is a poisonous disease in itself, and it is a normal person when cured. There are no toxins, no complications, no sequelae.
Many friends are now in deep thought: living is really too "south"! I don't want to deal with this devil in my life!
Don't be afraid, friends, tetanus is hard, it can be "broken"! Tetanus vaccines and tetanus injections are trustworthy.
Children can only do multiple choice questions, and adults do not make choices! I'm going to... Well, if you want it, you want it!
But the premise is that you understand the difference between tetanus vaccine vs tetanus injection?
Tetanus vaccine, is tetanus toxoid, to put it bluntly, it is actually the "virus virus", after artificial attenuation, reduce the toxin and activity, after entering your body, the immune system is stimulated, self-producing antibodies. When the real virus hits, there are antibodies to protect! Therefore, the vaccine is an antigen and belongs to active prevention.
Mainland China has been implementing immunization since the 1970s, and at present, the children's immunization uses tetanus multiple vaccines, a total of 5 doses, the first 4 doses are pertussis-diphtheria-tetanus combined vaccine, which are injected intramuscularly in 3 months, 4 months, 5 months and 18 months after birth, and the 5th dose is the combined diphtheria-tetanus vaccine, which is applied at the age of 6.
Adults who have not been previously immunized are usually given a multiple vaccine in the deltoid muscle of the upper arm, with the first two doses separated by 4 to 8 weeks, and a third intensive injection after half a year or one year [3].
The tetanus needle, which is the "antibody body", can be directly injected to obtain antibodies, called passive immunity. It has two sources: one is human tetanus immunoglobulin, also known as "human breakdown" (TIG), derived from people, such as some people with tetanus antibodies after donating blood, the extracted antibodies, the protection period after injection is 2 to 3 weeks, "human breakdown" process is complex, the number is relatively small.
One is tetanus antitoxin, also known as horse breaker (TAT), derived from horses, simply put, after the horse is injected with a vaccine, the antibodies produced on the horse are produced, and then the antibodies are extracted. "Horse breaker" in the human body stay time is short, the protection time is only 2 to 4 days, because it is an animal serum product, some people will be allergic, so do a skin test before injection.
If I accidentally get stuck in a nail, should I get vaccinated or break the cold shot?
Those who have been vaccinated against tetanus are generally limited to 5 years:
Within 5 years, if you have received 3 shots of tetanus and completed the full immunization, then the antibodies in the body are very high, and there is no need to vaccinate or break the cold injections at this time.
Beyond 5 years, if you encounter a low-risk wound (broken skin, shallow wound), the existing antibodies in the body can completely cover it. If it is a high-risk wound (the wound is deep and close to the center), a shot of vaccine is enough, and soon the antibody content in the body will be raised.
If it exceeds 10 years, no matter what wounds you encounter, you don't need to break the shot of the shot.
Previously unvaccinated or undocumented:
There had been no previous vaccinations, no antibodies in the body, and no immune memory. If you encounter a low risk of wounds, get one shot of tetanus injection, and then supplement the remaining immunization needles to complete the full immunization of three doses.
If the wound is heavily contaminated, a tetanus injection is required, of course, this is only a temporary protection, and then the tetanus vaccine needs to be supplemented.
However, it should be noted that after the injury, the sooner the tetanus needle is injected, the better, generally no more than 24 hours. However, there is still value in injections after exceeding them, because although tetanus can develop within 24 hours, the incubation period can be a week or more.
Every wound in life deserves attention, so, Erebati, be sure to protect yourself outside! Try not to hurt yourself, whether it's an external injury or an internal injury!
bibliography
[1] Centers for Disease Control and Prevention ( CDC) ． Epidemiology and prevention of vaccine － preventable diseases［M］． 10th ed．Washington，DC: Public Health Foundation，2008: 273 － 282．
Yang Guibo,Wang Chuanlin. Current situation and common misunderstandings of tetanus prevention[J]. Journal of Trauma Surgery,2014,16(01):94-96.
ZHANG Wei. Expert consensus on emergency prevention and diagnosis and treatment of tetanus in adults[J]. Journal of Clinical Emergency Medicine,2018,19(12):801-811.
*The other pictures in this article are from the medical illustrations of Zhanku Helo and Tencent Medical Code.
*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.
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