Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter XI: Infection
United States Department of Defense
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Reviewed
The surgical care of wounds should be immediate. The most important features of surgical wound care are thorough cleansing and debridement. Foreign bodies and necrotic tissue can be contaminated massively with Clostridium tetani and establish wound conditions promoting growth and exotoxin production. The wounds should be left open until the patient has recovered from the convulsion stage of disease Antibiotic therapy with penicillin is effective against the vegetative cells of Clostridium tetani. Treatment of patients with severe tetanus involves the use of muscle relaxants and sedation. as well as maintenance of fluid and electrolyte balance. Pulmonary toilet is necessary, as is elimination of visceral stimuli such as distention of the urinary bladder and fecal impaction. Careful nursing care is required. Translaryngeal intubation or even tracheostomy may be useful in maintaining a patent airway in patients who undergo frequent episodes of respiratory failure.
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