Tetanus shot there are 2 kinds, namely anti-tetanus serum (ATS) and the vaccine tetanustoxoid. ATS 1,500 IU is a serum that can directly prevent tetanus. Meanwhile, 0.5 ml of tetanus toxoid vaccine to prevent tetanus is not the time, but to establish immunity against tetanus, which prevents the occurrence of tetanus in the future if it is wound is still loaded with germs, also prevent tetanus in other events within about -about 6 months if no booster.
ATS (Anti Tetanus Serum) including passive immunization can be an antitoxin bovine (cow origin) or equine antitoxin (equine origin). Dose given to adults is 1500iu per IM, and for children is 750iu per IM. While tetanus toxoid including active immunization given at a dose of 0.5 cc IM, given 1 x month for 3 consecutive months.
II.1. Anti Tetanus Serum
• Name: Tetanus antitoxins.
• Physicochemical properties: Serum is made from horse plasma dikebalkan against tetanus toxin. Plasma is purified and concentrated and contains 0.25% phenol as a preservative.
• The dosage: 1 ml ampoule (1,500 IU), 2 ml (10,000 IU). 5 ml vial (20,000 IU)
• Pharmacology: Neutralize toxin produced by Clostridium tetani and is used to provide temporary passive immunity against tetanus, but the tetanus immunoglobulin is preferred.
II.2. Indications are given ATS (Anti Tetanus Serum)
Indications injection ATS (Anti Tetanus Serum):
o Injury quite large (in more than 1 cm)
o Injury from dirty and rusty objects
o animal and human bite wound
o Gunshot wounds and burns
o Wound contamination, namely: cuts of more than 6 hours left untreated, or injuries but less than 6 hours of exposure to a lot of contamination, or less than 6 hours of injury, but arises because a large enough force (eg lukatembak or pinched engine)
o People do not have a clear history of tetanus immunization or did not receive a booster for 5 years or more
II.3. Tetanus antitoxin Giving
Giving serum in therapeutic doses to ATS for adults is at 10000-20000 IU IM for children by 10.000IU IM. Providing therapeutic doses of antitoxin selma 2-5 days in a row.
II.4. How the ATS
Giving injections to patients who indicated ATS ATS is given, to neutralize endotoxins produced by the tetanus bacteria, preventing a bad prognosis, injected IM (intramuscular)
- Neutralizes endotoxins from tetanus germs
- Reduce death and disability
- Patients were given an explanation of the actions to be performed
II. Preparation Tool
- Disposible 3 cc 2 pieces
- Disposisble 5 cc 1 piece
- Cotton alcohol
- Grail crooked
- Nurses wash their hands
- Patients were told the procedure to be performed
- Before doing skin test first injected intra cutan
- Observe Skin test reaction
a. If the result is negative (-) ATS directly injected intra-muscular (IM)
b. When the results of (+) positive, the drug should be injected bedreskad
How Bedreskad injection execution:
i. Serum + 0.1 cc of 0.9% NaCl or 0.9 cc of distilled water, was injected sub Cutan wait for 30 minutes.
ii. Serum + 0.5 cc of 0.9% NaCl or 0.5 cc of distilled water, was injected sub Cutan, wait up to 30 minutes
iii. If there is no significant reaction after 30 minutes remaining in the serum can be intramuscular injections.
II.5. Test Sensitivity to ATS
Conducted to determine whether a patient is resistant to animals or ATS. To perform the test there are two ways yaiu skin test (skin test) and test maa (eye test).
a. Skin test. Often done, how that 0.1 cc of serum was diluted with distilled water or 0.9% NaCl fluids to 1cc. Then the next shot in the arm by intracutaneous voler, wait for 15 minutes. Positive reaction (patients hypersensitive to serum) in case of infiltrates / induration with a diameter greater than 10mm (1cm), which may be accompanied by a burning sensation and itching.
b. Eye test. The trick is to shed one drop of serum fluid in the eye, wait at least 15 minutes. The positive reaction when the eyes red and swollen.
II.6. Prophylactic action
Types of injuries Not Getting IA IA or partially complete
1-5 years Obtaining a complete IA
> 5-10 years Obtaining a complete IA
Lightweight, Clean Start or complete IA
Toks. 0.5 cc to complete - Toks. Toks 0.5 cc. 0.5 cc
Weight, clean, or tends to tetanus ATS 1500 IU
Toks.0, 5cc Toks. Toks 0.5 cc. 0.5 cc ATS 1500IU
Toks. 0.5 cc
Tend tetanus, debridement of late, or not clean ATS 1500 IU
Toks. 0.5 cc
Until ABT Toks complete. Toks 0.5 cc. 0.5 cc
ATS ABT 1500IU
Toks. 0.5 cc
IA = active immunization (with toxoid)
Toks. = Toxoid (adsorbed tetanus)
ABT = high dose of the appropriate antibiotics for Clostridium tetani.
1. Bachsinar Bob,dr.Bedah minor. Cetakan III. 1996.
2. Sjamsuhidajat, R & Wim de Jong, Buku Ajar Ilmu Bedah, Edisi Revisi, EGC, Jakarta:1997, hal 72-81.
3. Schwartz, Intisari Prinsip-Prinsip Ilmu Bedah.EGC, Jakarta: 2003