Adventure Sports First Aid Travel Health Wilderness

Tetanus, wounds and the wilderness

How many times have you been outdoors and had a cut, scrape or poke? This a common event and inherent to adventuring in the bush. Unfortunately, most people I know are un-aware of their protection against Tetanus, also known as “lockjaw”.

Tetanus is actually caused by a bacteria (Clostridium Tetani) that produces a special toxin which is the main cause of the problems. The bacteria itself is easy to kill with heat and antiseptic solutions. The spores are very resilient and difficult to kill. Tetanus generally occurs when the spores germinate and begin to grow in the tissue, producing their toxin.

Clostridium Tetani is found worldwide and lives in the soil and feces. So, it stands to reason that wounds contaminated with soil or feces are at high risk of tetanus infection. The term “tetanus prone wound” is used to describe any break in the skin that is heavily contaminated with natural material or debris; especially puncture wounds (rusty nails), burns or crushing injuries.

Tetanus is diagnosed mainly on the symptomsof the patient and the immunization history. As seen in the picture above, Tetanus causes sever muscle spasm and rigidity. This muscle spasm is what has lead to the nickname of the disease, “lockjaw” or trismus. This is due to the jaw muscles contracting and appearing to lock the jaw clenched. Risus Sardonicus (devil’s smile) can also occur when the muscles of the face spasm and contract. Muscle and jaw stiffness are often the initial presentations of the illness with fist clenching, arm and leg muscular rigidity and difficulty swallowing being the more severe symptoms. Death generally occurs from cardiac arrhythmias or hyperpyrexia (fever).

Prevention of Tetanus is a simple matter, actually. Get immunized! Most children in the developed world are vaccinated during childhood with the DTaP vaccine. This combo-vaccine covers Diphtheria, Tetanus and Pertussis. Adults get the Td vaccine/booster which only covers Tetanus and Diphtheria.

Maybe is it the primary care doctor in me, but I think everybody should know when they got their last tetanus shot! A booster shot is advised every ten years, even if you haven’t had any rusty nails, cuts or dirty wounds. Remember that the majority to tetanus cases occur in un-reported wounds, meaning the person had not been re-vaccinated in the last ten years and didn’t think the wound was dirty or likely to get infected. Now think about how many cuts, scrapes or gouges you get while outdoors biking, running hiking or whatever it is you do. I get a lot! A Tetanus Booster is also advised when there is a “dirty” wound and the last immunization was greater than 5 years ago. The vaccine is a simple matter of one injection (0.5mL), given in the arm or butt.

Good care of any wound is an important first step.  This should involve thorough debridement of any foreign bodies and a cleaning/irrigation with soap and water.  Antiseptic towelettes work great, as well. There are several commercial kits available for basic wound care.

So, you’ve got a potentially fatal disease that enters the body through cuts, scrapes or breaks in the skin and lives in contaminated soil. The notion of bringing my skin and soil together is one of the reasons why I am actually outdoors in the first place! Sometimes I cannot always control the forces that bring my skin and the soil together and I break my skin. I now have soil and broken skin together and need to make sure my tetanus status is up-to-date.

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