Clinical rational application of tetanus antitoxin

Wei Xiufen，Wang Erni
Chinese classification number：R472.9              Document identification code：C
Transfer article number：1672-1888（2008）10B-2697-01

Since its inception, tetanus antitoxin has been widely used in clinical practice because of its good efficacy and low price. Injection of tetanus antitoxin is an extremely important measure to prevent and treat tetanus. Use of tetanus antitoxin should pay attention to: 1 Do not use tetanus antitoxin for any trauma. It is reported that children who have received vaccination for the whole process can not be injected with tetanus antitoxin within 5 years, and those with severe wound contamination can be injected with tetanus toxoid to boost immunity. Repeated application of tetanus antitoxin can also reduce the efficacy and prone to allergic reactions. 2 Those who are allergic to tetanus antitoxin should not be desensitized. The use of tetanus immunoglobulin instead of clinical application is effective and safe, and does not require a skin test.
1. Typical cases
[Example 1] Male, 47 years old. Because of facial trauma, debridement and suture, as prescribed by the doctor, intramuscular injection of tetanus antitoxin 1500U. Skin test positive, given desensitization injection. The first time, the remaining amount of skin test was injected and observed for 20 minutes without reaction. After 5 minutes of the second injection, the patient developed chest tightness, palpitation, and shortness of breath, and immediately relieved after anti-allergy treatment.
   [Example 2] Male, 15 years old. Due to head trauma, tetanus antitoxin 1500U was given intramuscularly after surgical treatment. Asked about no history of allergies, 15U tetanus antitoxin was injected according to the routine flesh, 5 minutes after the injection site was red and swollen, and the patient was closely observed. About 10 minutes, the patient had wheal of wheal on the forearm. Immediately notify the doctor that the patient had been in the process of preparation. General urticaria, but the patient is in good spirits and has no other discomfort. According to the doctor's advice, intramuscular injection of 10mg dexamethasone, intravenous infusion of 5% glucose hydrocortisone 200mg, urticaria gradually subsided, the liquid was cured after the drop.
2. Judgment on the results of the tetanus antitoxin skin test
In the textbook, the tetanus antitoxin allergy test has only negative and positive criteria. There is no treatment for those who are neither negative nor positive. Due to the vague concept, desensitization injections are generally given to those who do not meet the negative judgment criteria. Desensitization injection not only adds pain to the patient, but also increases the workload for the nurse. It also finds a basis for desensitization injection.
The reason for the high positive rate of tetanus anti-toxin skin test: 1 The content of tetanus anti-toxin skin test is high. The tetanus antitoxin produced by the Lanzhou Institute of Biological Products used in our hospital is only 0.6ml per 1500U, and it is not less than 1500U per bottle. 2 Prepare the skin test solution using water for injection. The low osmolality of water for injection causes false positives and increases pain in the patient. 3 operator intradermal injection is not standard. When the intradermal injection is at a large angle between the needle and the skin, the drug solution is injected into the skin, and the amount of the injection is increased because the skin is not obvious.
In summary, our department began to use the wounded anti-toxin skin test solution in 2000 to dilute the original solution plus normal saline to 1ml, and then use its 0.1ml skin test solution, the false positive rate is greatly reduced, tetanus antitoxin The utilization rate was over 90%, and no abnormal reaction occurred in the patient.
references:
[1] Li Gaiping, Liu Fuying, 2 cases of allergic reactions to desensitization and injection of tetanus antitoxin [J], family nurse, 2007.5 (11C): 24.
Author brief introduction Wei Xiufen, Wang Erni Work unit: 454000, Henan Province Jiaozuo Coal Industry Group Wuguan Hospital.