(精选)Point-of-care tetanus immunoassay教学课件.pptVIP

* * * * * * International Trauma Care Conference Telford, May 2010Point-of-care tetanus immunoassay Dr Tricia Scott Ph.D. RGN, Senior Research Fellow, Department of Academic Emergency Medicine, South Tees Hospitals NHS Trust Tetanus Life threatening infection Injury infected by clostridium tetani Anaerobic organism Deep penetrating wounds Releases potent neurotoxin First symptom is ‘lockjaw’ Paralyses muscles Woody, R.C. and Ross, E.M. (1989) Neonatal tetanus (St Kilda, 19th Century). The Lancet, June 10, p 1339 “Between 1855 and 1876 accurate infant birth and death records were kept…During that period there were 41 infant deaths out of 56 births; most of these deaths were ascribed to “sickness of eight days” …In 1890, the Rev. Angus Fiddes, who was convinced that the neonatal tetanus was the result of birth practices, decided to act. Fiddes believed that the traditional birth ritual of anointing the cut umbilical cord with a rag soaked in salt butter or other oils was responsible… ..Instead of using salt butter, which was scarce on the island, she (midwife) used the ruby-red oil from the fulmar, a local bird. This oil was stored in the dried stomach of a solan goose, a container used for years without cleaning.” Tetanus trajectory Muscle spasm then rigidity: Initially jaw muscles (lockjaw) Leading to neck rigidity Localised e.g. cranial nerve palsy after head wound Seizure–like activity Risus sardonicus Intense pain Opisthotonos - intensifies with sudden noises Respiratory failure and mortality Treatment Muscle relaxants Airway support Human anti-tetanus immunoglobulin Fluid support Antibiotics Open the wound, cleanse, debride ITU UK Incidence (10 August 2009) WHO Immunizationand Surveillance, Assessment and Monitoring[accessed 30 November 2009] 2008 5 2007 4 2006 3 2005 10 2004 20 2003 14 2002 7 2001 7 2000 2 1999 No data 1998 No data 1997 9 1996 10 1995 7 1994 4 1993 8 1992 7 1991 8 1990 18 1989 22 1988