th participation of the anesthesiologist. It is necessary to provide the guarding mode excluding acoustical, visual and tactile irritants. Feeding of patients is carried out via the probe or parenterally (at GIT paresis). Carry out prevention of decubituses: frequent turning of the patient in beds, smoothing crumpled bed and underwear, its cleaning and periodic change. The contaminated wound which even healed is cut away antitetanic serum (in a dose 1000-3000 ME), then carry out careful audit and surgical treatment of a wound with wide lampasny cuts (for creation of aerobic conditions), removal of the foreign bodys polluted and nekrotizirovanny fabrics. For the prevention of spasms it is better to carry out all these manipulations under anesthetic. In the subsequent it is reasonable to apply proteolytic enzymes to treatment of wounds (trypsin, chymotrypsin, etc.).
For neutralization of a spasmotoxin in a blood-groove once enter intramusculary 50 000 ME of antitetanic serum or 1500-10 000 PIECES (an average dose of 3000 PIECES) of specific immunoglobulin with preliminary check of individual sensitivity to them. These drugs should be administered in the earliest terms as the tetanin freely circulates in blood no more than 2-3 days, and the connected toxin is not inactivated that reduces therapeutic effect. After administration of heterogeneous antitetanic serum it is necessary to watch the patient during 1 h because of danger of development of an acute anaphylaxis.
Fight against a convulsive syndrome is carried out by use of sedative and narcotic, neuroplegic means and muscle relaxants. Recently widely each 2-4 h use diazepam on 5-10 mg inside; in hard cases it is entered intravenously on 10-20 mg by each 3 h. To children drug is appointed intravenously or intramusculary on 0,1-0,3 mg/kg by each 6 h (as much as possible to 10-15 mg/kg/days). It is possible to apply injections of mix of 2,5% of solution of aminazine, 1% of solution of Promedolum and 1% of solution of Dimedrol (on 2 ml of each drug) with addition of 0,5 ml of 0,05% of solution of Scopolaminum of hydrobromide. Also appoint Seduxenum, barbiturates, sodium hydroxybutyrate, in hard cases - Droperidolum, fentanyl, kurarepodobny muscle relaxants (pankuroniya, d-tubocurarine). At lability of a sympathetic nervous system sometimes apply and - and ß blockers. At disorders of breath carry out an intubation or tracheotomy, combine muscle relaxation with IVL, clarification of respiratory tracts an aspirator; patients are given the moistened oxygen. There are messages on efficiency of hyperbaric oxygenation.
In small doses appoint purgatives, put a colonic tube and a catheter in a bladder (if necessary). Frequent turnings of the patient, a forcing of breath and cough are necessary for prevention of pneumonia.
To the prevention and treatment of bacterial complications apply antibiotics - benzylpenicillin on 2 mln units of intravenously bucketed 6 h (to children to 200 000 PIECES/kg/days), tetracycline on 500 mg 4 times a day (to children to 30-40 mg/kg/days). Use of antibiotics does not exclude a possibility of development of pneumonia and other consecutive infections.
Fight against a hyperthermia, acidosis and dehydration is carried out by intravenous injections of 4% of solution of sodium bicarbonate, polyionic solutions, Haemodesum, reopoliglyukin, albumine, plasma.