Maqeba a Tebileng, Ho hata Lenala, le Thibelo ea Tetanus¶

Stepping on a nail, piercing the skin with a rusty fence wire, getting jabbed by a rose thorn or wooden splinter, or suffering a deep puncture wound creates a uniquely deceptive medical emergency. Unlike wide surface cuts that bleed freely and are easy to wash out, a narrow puncture object acts like a hypodermic needle. It drives soil bacteria, anaerobic Clostridium tetani spores, and fragments of shoe rubber or sock lint deep into subcutaneous fat, plantar fascia, joint capsules, or bone periosteum, and then the elastic skin seals shut behind the blade or point.

This guide provides step-by-step emergency procedures aligned with clinical recommendations from the World Health Organization (WHO), the United States Centers for Disease Control and Prevention (CDC), the UK Health Security Agency (UKHSA), the American College of Foot and Ankle Surgeons (ACFAS), and the Infectious Diseases Society of America (IDSA). Acting promptly to irrigate the wound without sealing it shut, verifying your 5-year vs. 10-year tetanus booster status, and watching for Pseudomonas aeruginosa cartilage or bone infection if a nail pierced through a sneaker prevents permanent disability and life-threatening tetanus.

Etsa sena hona joale¶

If you or someone nearby steps on a nail, thorn, glass shard, metal wire, or suffers any deep puncture wound:

1. Sit down and check whether the object is still embedded: Take all weight off an injured foot immediately. If a small nail, tack, or thorn is sticking lightly into the sole of your shoe or shallow skin and pulls out effortlessly as you lift your foot, remove your shoe and sock carefully. However, if a large spike, rebar rod, glass shard, or wooden stake is deeply impaled into the foot, hand, or body, or passes all the way through a limb, DO NOT pull it out. Stabilize the object in place with bulky padding (see our impalement stabilization guide) and call your local emergency number (911 in the United States and Canada, 112 across the European Union, 999 in the United Kingdom) via our dinomoro tsa tshohanyetso directory.
2. Control heavy bleeding while allowing brief capillary oozing for minor punctures: If blood is spurting or pooling rapidly, apply firm direct manual pressure with a clean cloth or sterile gauze pad for 10 full minutes (see severe bleeding control). If the puncture is only oozing a few drops of dark venous blood, allow it to bleed gently for 30 to 60 seconds while you move to the sink, as outward blood flow helps flush dirt and bacteria out of the narrow tract.
3. Wash and irrigate under pressurized running tap water for 5 to 10 minutes: Hold the puncture wound directly beneath a strong stream of clean running tap water and wash the surrounding skin thoroughly with mild household soap for 5 to 10 minutes. Gently spread the edges of the puncture opening with clean fingers so running water can flush into the mouth of the tract, but never poke cotton swabs, tweezers, or needles deep inside the hole.
4. Inspect the object and your footwear for missing pieces: Look closely at the nail, thorn, or splinter that caused the injury and inspect the bottom and inside of your shoe and sock. If the tip of a wooden splinter or thorn broke off inside your foot, or if the nail punched through the foam rubber sole of an athletic sneaker or work boot, tell the examining physician immediately.
5. Cover loosely with a sterile dressing (never seal a puncture wound shut): Apply a thin layer of plain petroleum jelly or over-the-counter antibiotic ointment around the surface and cover with a sterile gauze pad and light bandage. Never seal a puncture wound closed with cyanoacrylate skin glue, butterfly tape, or liquid bandage, which traps anaerobic Clostridium tetani spores inside an oxygen-free chamber.
6. Seek same-day medical evaluation for tetanus prophylaxis and deep foreign bodies: Visit an urgent care clinic or emergency department the same day if the object was dirty or outdoors, if a nail went through a shoe or sneaker, if the puncture is on a joint, hand, or foot, or if you have not had a tetanus booster within the last 5 years.

Emergency triage and tetanus prophylaxis decision flowchart¶

flowchart TD
    Start["Deep Puncture Wound (Nail, Thorn, Splinter, Wire, Glass)"] --> Impaled{"Is the object deeply impaled or stuck in bone/joint?"}

    Impaled -->|Yes: Deeply Embedded or Through-and-Through| LeaveIt["DO NOT REMOVE OBJECT<br/>Stabilize with bulky dressings around shaft<br/>Call 911 / 112 / 999 or transport to Emergency Department"]

    Impaled -->|No: Object came out cleanly| Irrigate["Immediate High-Volume Irrigation<br/>Allow 30-60s minor oozing, then wash with soap and<br/>pressurized running tap water for 5 to 10 minutes<br/>Cover loosely with sterile gauze; NEVER glue shut"]

    Irrigate --> RiskCheck{"Are any High-Risk Surgical/Infectious Features present?"}

    RiskCheck -->|Nail pierced through a rubber-soled sneaker/boot| Sneaker["High Risk of Pseudomonas Osteochondritis<br/>Same-day Urgent Care / ED evaluation for surgical coring,<br/>foreign body removal (sock/foam), and targeted care"]
    RiskCheck -->|Retained wooden splinter, thorn, or glass fragment| Retained["Same-Day Medical Imaging & Extraction<br/>Ultrasound (for wood/thorns) or X-ray (for metal/glass)<br/>plus sterile local-anesthetic removal"]
    RiskCheck -->|Clean, shallow puncture without retained material| TetanusEval["Evaluate Tetanus Immunization Status Immediately"]

    LeaveIt --> TetanusEval
    Sneaker --> TetanusEval
    Retained --> TetanusEval

    TetanusEval --> VaxHist{"Has patient completed >= 3 lifetime doses of Tetanus Vaccine?"}

    VaxHist -->|No, Unknown, or < 3 Doses (Dirty/Puncture Wound)| FullPEP["Administer BOTH on Day 0 (in separate limbs):<br/>1. Tetanus Vaccine (Tdap or Td)<br/>2. Tetanus Immune Globulin (TIG 250 IU IM)"]
    VaxHist -->|Yes (>= 3 Doses): Last booster >= 5 years ago| FiveYr["Administer Tetanus Booster (Tdap or Td) within 48h<br/>(5-Year Rule applies to all dirty/puncture wounds)<br/>No TIG needed unless severely immunocompromised"]
    VaxHist -->|Yes (>= 3 Doses): Last booster < 5 years ago| Covered["Tetanus Immunity Fully Current<br/>No vaccine or TIG required; monitor for bacterial infection"]

Pathophysiology of puncture wounds: why tiny holes cause severe infections¶

When you slice your finger with a clean kitchen knife, the cut opens linearly, bleeds briskly, exposes the tissue to atmospheric oxygen, and allows soap and water to reach the bottom of the wound. A deep puncture wound behaves in the exact opposite mechanical and biological manner.

The anaerobic trap mechanism¶

1. Deep piston inoculation: When a sharp cylindrical object like a nail, awl, pitchfork tine, or thorn penetrates the skin under body weight, it acts like a piston. It shears through the tough outer stratum corneum and drives surface skin bacteria (Staphylococcus aureus and Streptococcus pyogenes), soil spores (Clostridium tetani), and microscopic plugs of epidermal tissue, sock lint, and shoe rubber 10 to 30 millimeters (0.4 to 1.2 inches) deep into poorly vascularized fat, fascia, tendons, or bone.
2. Letlalo le bopehileng hantle le tiisa bokaholimo: Hang ha lenala le ntšoa, likhoele tsa kholajene tse boreleli tsa letlalo le letlalo le letenya la semela li hohla hammoho joalo ka valafo ea rabara e itšebang. Ka mor'a metsotso e seng mekae, lesela le lenyenyane la fibrin le koala lesoba le ka holimo la limilimithara tse peli.
3. Ho fokotseha ha oksijene le necrotic hematoma: Ka har'a pampitšana e koetsoeng e ka tlas'a letlalo, libethe tsa capillary tse pshatlehileng li lutla pokotho e nyane ea mali a emeng (micro-hematoma) haufi le lisele tse senyehileng le likhoele tsa kantle. Likokoana-hloko tsa Aerobic (joaloka Staphylococcus) li ja ka potlako palo e nyane ea oksijene e qhibilihileng e setseng ka pokothong, e fokotsa monyetla oa ho fokotsa oxidation (redox) ea lehae hore e be haufi le lefela.
4. Ho mela ha li-anaerobes tse tlamang: Li-endospore tse robetseng tsa Clostridium tetani ha li khone ho mela liseleng tse phetseng hantle, tse nang le oksijene hantle. Leha ho le joalo, hang ha li koaletsoe ka har'a mokotlana ona o lefifi, o futhumetseng, o senyehileng oa oksijene, o fokotsehile, li-spores li mela ka har'a libaktheria tsa limela tse sebetsang 'me li qala ho hlahisa tetanospasmin, e leng e' ngoe ea li-neurotoxin tse bolaeang ka ho fetisisa tse tsejoang ke saense.

CDC le WHO Tetanus Prophylaxis Matrix: melao ea lilemo tse 5 khahlano le lilemo tse 10¶

Hobane likokoana-hloko tsa tetanase li nka kae kapa kae ho tloha matsatsing a 3 ho isa ho a 21 (karolelano ea matsatsi a 7 ho isa ho a 10) ho mela le ho hlahisa chefo, ho fumana prophylaxis ea post-exposure tetanus prophylaxis hang ka mor'a hore kotsi e emise lefu pele le ka hlaha. Lingaka li etsa qeto ea hore na u hloka ente e matlafatsang ente ea tetanase u le mong, kapa ente ea thibelo ea tšoaetso ea tetanus le Tetanus Immune Globulin (TIG), ka ho tšela lintlha tse peli: khethollo ea maqeba le histori ea bophelo bohle ba hau ba ente.

Mohato oa 1: Hlophisa leqeba (Ho hloekile/Nnyane khahlano le Litšila/Tetanus-Le Prone)¶

Public health agencies (CDC, WHO, UKHSA) divide all wounds into two categories:

• Clean and Minor Wounds: Superficial, linear cuts or scrapes sustained indoors with a clean object (such as a clean kitchen knife or paper cut), under 6 hours old, with smooth edges, no crushed tissue, and zero contact with soil, street dirt, saliva, or feces.
• All Other Wounds (Dirty or Tetanus-Prone Wounds): Nearly all outdoor puncture wounds fall into this category. This includes any wound contaminated with dirt, soil, street dust, rust, feces, or saliva (including animal and human bites); deep puncture wounds (stepping on a nail, thorn, splinter, or needle); avulsions; crush injuries; burns; frostbite; projectiles; or any wound containing devitalized tissue or foreign bodies.

Step 2: Apply the official CDC/WHO Tetanus Immunization Table¶

Understanding Tdap vs. Td and Tetanus Immune Globulin (TIG)¶

1. Why "I had a tetanus shot 7 years ago" is NOT enough for a nail puncture: Many adults remember hearing that tetanus shots last for 10 years. While a 10-year interval is sufficient for clean, minor indoor cuts, circulating antitoxin antibody levels gradually decline between years 5 and 10. For a dirty or deep puncture wound (like stepping on a nail or garden tool), clinical guidelines enforce the 5-year rule: if your last booster was 5 or more years ago, you need an immediate booster shot to trigger a rapid secondary antibody surge.
2. Which vaccine is given (DTaP vs. Tdap vs. Td):
3. Children under age 7: Receive DTaP (pediatric diphtheria, tetanus, and acellular pertussis vaccine).
4. Adolescents and Adults (age 11 and older): Receive Tdap (tetanus, reduced diphtheria, and acellular pertussis) if they have not previously received a dose of Tdap as an adult, or if they are pregnant (to pass pertussis antibodies to the baby), or Td (tetanus and diphtheria). Either Tdap or Td provides identical, full protection against tetanus.
5. When Tetanus Immune Globulin (TIG) is mandatory: A tetanus vaccine shot stimulates your own immune system to build antibodies, which takes several days in someone who has previously completed their childhood 3-dose series, and takes weeks in someone who was never vaccinated. Therefore, if a person with an unknown vaccination history or fewer than 3 lifetime doses suffers a nail puncture or dirty wound, the vaccine alone will not act fast enough. The hospital must also inject 250 International Units (IU) of Human Tetanus Immune Globulin (TIG) intramuscularly at a separate anatomical site to provide immediate passive antitoxin neutralization while the vaccine kicks in.
6. How soon after a puncture wound should you get the tetanus shot?: Ideally within 24 to 48 hours of the injury. However, even if you delayed seeking care for several days or a week after stepping on a nail, you should still get your tetanus booster or TIG immediately, because the incubation period of tetanus can extend up to 21 days or longer.

The "Sneaker Nail" Emergency: Pseudomonas aeruginosa osteochondritis¶

One of the most important orthopedic pearls in emergency medicine involves stepping on a nail that punctures through the sole of a sneaker, tennis shoe, or rubber-soled work boot as opposed to stepping on a nail with a bare foot.

Why a nail through a sneaker is more dangerous than a barefoot puncture¶

While a barefoot nail puncture primarily introduces soil organisms and skin flora (Staphylococcus and Streptococcus), a nail that punches through the bottom of a sneaker passes through the warm, damp, sweat-soaked inner polyurethane or EVA foam midsole of the shoe.

• Foam ea lieta ke incubator bakeng sa Pseudomonas aeruginosa: Liphuputso tsa likokoana-hloko li bontša hore lesela le mongobo, le nang le marotholi ka hare ho liteki tsa lipapali le lirifi tsa mosebetsi li kenngoa haholo ke Pseudomonas aeruginosa, baktheria e mabifi ea Gram-negative.
• **Ente e tobileng ka har'a lefufuru la leoto le lesapo **: Ha lenala le phunya seeta 'me le kena bohatong ba leoto, ntlha ea lona e mahoashe e hula likaroloana tse nyane tsa Pseudomonas-laden sneaker foam le sock fibers, e li kenya ka kotloloho ho plantar fascia, manonyeletso a manyane a lesapo la menoana ea menoana ea menoana ea menoana ea menoana ea menoana ea menoana ea menoana ea menoana ea menoana.
• Pseudomonas loves cartilage: Pseudomonas aeruginosa has a destructive affinity for avascular hyaline cartilage and bone periosteum. Within 2 to 7 days after a sneaker puncture, patients develop Pseudomonas osteochondritis or osteomyelitis: a deep, destructive bone and joint infection that destroys the joints of the foot if not surgically debrided and treated with anti-pseudomonal antibiotics.

Comparison of puncture wound scenarios and microbial targets¶

Mohato ka mohato thuso ea pele bakeng sa ho phunya maqeba le liphahlo¶

Tlhokomelo e nepahetseng ea maqeba ka metsotso e 30 ea pele e tlosa boholo ba lintho tse silafatsang holim'a metsi pele letlalo le li tiisa ka hare.

1. Mokhoa oa ho nosetsa ka mokhoa o sireletsehileng sepekere se secha kapa thapo ea terata¶

1. Hlapa matsoho a hao pele: Hlapa matsoho a hao ka sesepa le metsi 'me u apare liatlana tse hloekileng tsa bongaka ha u phekola motho e mong.
2. Khothalletsa metsotsoana e 30 ho isa ho e 60 ea ho tsoa ha venous (haeba mali a tsoa hanyenyane): Ntle le haeba mali a phalla kapa a phalla haholo, lesa lesoba la ho phunya hore le tsoe ka tlhaho nako ea halofo ea motsotso ha u ntse u bula faucet. U se ke ua petetsa kapa ua petetsa leqeba le pota-potileng leqeba, kaha ho petetsa ho ka sutumelletsa libaktheria ka har'a libethe tsa capillary tse haufi.
3. Nosetsa ka tlas'a metsi a pompo a hatelletsoeng ka metsotso e 5 ho isa ho e 10: Beha leoto kapa letsoho ka kotloloho tlas'a molapo o matla, o tsitsitseng oa metsi a pompo a hloekileng. Hlatsoa letlalo le potolohileng hantle ka sesepa le metsi ho tlosa litšila, mafome le masela a lieta monyako oa leqeba.
4. Se ke oa inela leqeba le phuntsoeng ka sekotlolong se emeng kapa bateng ea letsoai ea Epsom: Phoso e tloaelehileng ea lapeng ke ho kenya leoto le phuntsoeng ka bateng kapa beineng ea metsi a futhumetseng le letsoai la Epsom hang ka mor'a kotsi. Ho inela ka metsing a emeng ho fetola beisine ho ba sopho e futhumetseng ea baktheria e entsoeng ho tsoa litšila tse holim'a leoto la hau, ebe e kenella ka mokhoa o sa reroang ka pampitšaneng ea ho phunya. Kamehla sebelisa metsi a phallang a hlatsoang litšila ho theosa le draina.
5. Qoba lik'hemik'hale tse matla tsa cytotoxic ka har'a ho phunya: U se ke ua tšela hydrogen peroxide e sa lokisoeng, ho tlotsa joala, kapa bleach leqebeng le tebileng la ho phunya. Hydrogen peroxide e phophoma haholo ha e kopana le catalase ea mali, e shebahalang e khahla empa ha e le hantle e senya lisele tse tšoeu tsa mali tse phetseng hantle (neutrophils) le fibroblasts ha e ntse e theha lisele tse shoeleng tse nyane tse ratang kholo ea anaerobic Clostridium tetani. Metsi a hloekileng a phallang le sesepa se bobebe (kapa letsoai le hloekisitsoeng le tloaelehileng la letsoai le aqueous povidone-iodine) li bolokehile haholo ebile li sebetsa.
6. Tla setlolo se phefumolohang, se sa koalehang: Koala letlalo le haufi le lona ka lesela le hloekisitsoeng, tšela seaparo se bobebe sa jeli ea petroleum kapa setlolo se nang le lithibela-mafu tse tharo ho thibela lekhalo hore le se ke la koaloa pele ho nako, 'me le koahele ka lesela le hloekisitsoeng le sirelelitsoeng ka theipi ea pampiri kapa letlapa la rolara. Fetola moaparo letsatsi le leng le le leng 'me u boloke leoto le phahame ha u lutse ho fokotsa edema e otlang.

2. Ke neng le joang ho tlosa splinter kapa moutloa o ka holimo-limo lapeng¶

U lokela ho tlosa splinter kapa moutloa feela lapeng ha o ** o monyenyane, o sa teba, o lutse ka tlas'a letlalo le ka holimo (epidermis/superficial dermis), 'me o na le mohatla o pepenene oo u ka o tšoarang habonolo **.

• Senya lisebelisoa tsa hau: Hloekisa li-tweezers tse peli le nale ea ho rōka ka joala ba isopropyl ea 70%. Hlatsoa letlalo ho potoloha splinter ka sesepa le metsi.
• Hula ka lehlakoreng le nepahetseng la ho kena: Tšoara ntlha e hlahelletseng ea sekhahla ka li-tweezers haufi le bokaholimo ba letlalo ka hohle kamoo ho ka khonehang, 'me u se thellele ntle hantle ka lehlakoreng le tšoanang le leo e kentseng ka lona. Ho hula ka ho toba ka angle ea 90-degree ho phunya lehong le brittle kapa rosa meutloa ka halofo, ho siea ntlha e patiloe botebong ba letlalo.
• **Haeba ntlha e sa koaheloe ke letlalo le shoeleng **: Sebelisa nale e hloekisitsoeng ka joala ho phahamisa ka bonolo marulelo a masesaane a phunyeletsang a karolo e shoeleng qetellong ea splinter ho fihlela li-tweezers li khona ho tšoara sefate sa patsi.
• O TLA ETSA Neng mme o ye ngakeng ho fumana splinter: Le ka mohla o se tjheke nama e dutlang lapeng hae haeba:
• Sekhahla se ** se tebile, se otlolohile, kapa se patiloe ka botlalo ** ka tlas'a letlalo le tiileng.
• Sekhahla se tlas'a lenala la monoana kapa monoana oa leoto (subungual) 'me se robehile.
• Sekhahla se ** haufi le leihlo**, ka holim'a lenonyeletso la monoana, kapa ** botebong ba bohato ba leoto**.
• Ntho e barbed (jwaloka sehakisi sa tlhapi kapa cactus glochid) kapa galase e robehang.
• Hobaneng lingaka li sebelisa Ultrasound ho e-na le X-rays bakeng sa lehong le meutloa: Manala a tšepe le likaroloana tse ngata tsa khalase li bonahala ka khanya ho X-ray e tloaelehileng (radiopaque). Leha ho le joalo, metsoako ea lehong, meutloa ea limela, li-cactus spines, le polasetiki ha li bonahale ho X-ray e tloaelehileng (radiolucent) maemong a fetang 85 lekholong. Tlhokomelo e potlakileng le lingaka tsa maemo a tšohanyetso li sebelisa bethe ** high-frequency point-of-care ultrasound (POCUS)** ho bona ka mahlo a kelello maqhama a patiloeng a lehong ho fihlela ho millimeter e le 'ngoe, ho kokobetsa leoto kapa letsoho ka mokokotlo oa methapo ea sebakeng seo, le ho ntša sekhechana sohle ntle le ho cheka ka bofofu.

Ho lemoha Tetanus ea kliniki ("Lockjaw") le mafu a tebileng a maqeba¶

Kaha maqeba a ho phunya a koala kapele ka holimo, hangata a shebahala a folile ka ho feletseng holim'a lihora tse 48 ha tšoaetso e tebileng e ntse e tsoela pele ka tlase, kapa ha chefo ea tetanus e tlama tsamaiso ea methapo.

Lifolakha tse khubelu tsa leqeba la baktheria kapa tšoaetso ea masapo (Matsatsi a 1 ho isa ho a 7)¶

Khutlela setsing sa maemo a tšohanyetso kapa tleliniking ea tlhokomelo e potlakileng hang-hang haeba u hlokomela leha e le efe ea matšoao a latelang ka mor'a leqeba la ho phunya:

1. Letšoao la "Letsatsi la 3 ho isa ho Letsatsi la 5 Rebound Pain": Bohloko bo tsoang ho poke ea mochini oa lenala bo lokela ho ntlafala butle-butle nakong ea lihora tse 48 tsa pele. Haeba leqeba le ikutloa le le betere ka Letsatsi la 1 le Letsatsi la 2, ebe ka tšohanyetso le hlaha ** ho mpefala, bohloko bo tebileng ba ho otla, mocheso, kapa ho ruruha ka Letsatsi la 3, 4, kapa 5 ** (haholo-holo haeba u sa khone ho jara boima ba bolo kapa serethe sa leoto la hao), belaella sebaka se tebileng sa plantar abscess kapa Pseudomonas osteochond.
2. Ho hasana ha erythema (bokhubelu) kapa mela e mefubelu: Bokhubelu bo atoloha ka ntle ho feta 1 ho isa ho 2 centimeters (0.4 ho 0.8 inches) ho tloha lesobeng la ho phunya, kapa mela e mefubelu e latellang leoto, leqaqailaneng kapa forearm ho ea lymph nodes (e nyolohang lymphangitis).
3. Mokelikeli o hloekileng kapa monko o mobe: Pulu e bosehla bo bosehla, bo botala, kapa bo bohlooho bo tsoang ka har'a pampitšana ea ho phunya ha e hatelloa, kapa monko o litšila o tsamaeang le maikutlo a hlabang ka tlas'a letlalo (**subcutaneous crepitus **, boemo ba tšohanyetso ba bongaka bo bontšang Clostridial myonecrosis / gangrene).
4. Matšoao a Kanavel a tšoaetso ea tendon ea monoana: Haeba moutloa, terata kapa lenala le phunya lehlakore la letsoho la monoana 'me monoana o ruruha ka mokhoa o lekanang joaloka boroso, o phomola hanyenyane, o ikutloa o le bonolo hohle lehlakoreng la palema la mothapo,' me o baka bohloko bo boholo ha u leka ho otlolla monoana ka potlako, e-ea sepetlele hang-hang.

Ho lemoha matšoao a methapo ea kutlo ea Tetanus e Akaretsang (Matsatsi a 3 ho isa ho a 21)¶

Tetanus ke ese bofubelu bo bonahalang kapa boladu sebakeng sa leqeba; ha e le hantle, leqeba la pele la ho phunya hangata le le lenyenyane kapa le se le folile nakong ea ha tetanase e qala. Tetanospasmin neurotoxin e khutlela morao hammoho le methapo ea motlakase ho ea lesapo la mokokotlo le boko ba boko, moo e thibelang ka ho sa feleng ho lokolloa ha li-neurotransmitters tse thibelang (glycine le GABA). Ntle le "li-brake" tse thibelang, li-motor neurone li tuka ka mokhoa o sa laoleheng, li koala mesifa ea masapo hore e be maqeba a bohloko, a tsitsitseng:

• Trismus ("Lockjaw"): Letšoao la pele ho bakuli ba fetang liperesente tse 75. Mesifa ea masseter ea mohlahare e ba e sataletseng le ho ba bohloko, ho etsa hore ho be thata kapa ho se khonehe ho bula molomo ka botlalo kapa ho hlafuna lijo.
• Risus sardonicus: Ho honyela ho sa feleng ha mesifa ea sefahleho ho hulelang likhutlo tsa molomo kantle ho serethe se tsitsitseng, se thata ka lintši tse phahamisitsoeng.
• Dysphagia le molala o sataletseng: Ho satalla ho tsoelang pele ha molala, 'metso le mesifa ea ho koenya, ho baka kotsi e kholo ea tšitiso ea moea le takatso.
• Opisthotonus le generalized tetanic spasms: Ho tiea ho matla, ho bohloko ha lerako la mpa (boto-joaloka mpa) le mesifa ea morao e koalang mokokotlo ka morao hore e be seqha se thata (**opisthotonus **). Mokuli o lula a le ** a hlokometsoe ka ho feletseng a bile a falimehile ** ho pholletsa le li-spasms tsena tse bohloko tsa 'mele oohle, tse ka hlahisoang ke lintho tse nyenyane tse kang khanya e khanyang, lerata la tšohanyetso, kapa ho ama,' me li matla hoo li ka robehang li-vertebrae kapa li-tendon tse tabolang.
• Ho hema le ho se tsitse ha mmele: Spasms of the vocal cords (laryngospasm) le diaphragm li thibela ho phefumoloha, ha li-spikes tse sa tsitsang tsa khatello ea mali le ho otla ha pelo ho baka lefu le bolaeang la pelo. Ho satalla leha e le hofe ha mohlahare, molala, kapa mesifa e koetsoeng ka mor'a leqeba la ho phunngoa ho hloka hore hang-hang sepalangoang sa ambulense sa 911 / 112 / 999 se lebe setsing sa tlhokomelo e matla.

Lipotso tse botsoang khafetsa¶

• Tataiso ena ke ea merero ea tlhahisoleseling, 'me ha e nke sebaka sa tlhahlobo ea bongaka ea litsebi kapa koetliso ea matsoho. Re khothaletsa ho nka thupelo e amohetsoeng ea thuso ea pele le CPR ka Mokhatlo oa Machaba oa Mokhatlo oa Sefapano se Sefubelu le Mekhatlo e Mefubelu (IFRC), sechaba sa hau sa naha sa Sefapano se Sefubelu, St John Ambulance, kapa mofani oa koetliso oa lehae ea tiisitsoeng.

Mehloli e hlahlobiloe¶

• Litsi tsa Taolo le Thibelo ea Mafu (CDC, United States): * Tataiso ea Kliniki bakeng sa Taolo ea Maqeba ho Thibela Tetanus* le Epidemiology le Thibelo ea Mafu a Thibeloang ke Ente (Buka e Pinki: Tetanus).
• Mokhatlo oa Lefatše oa Bophelo (WHO): Meento ea Tetanus: Pampiri ea Boemo ba WHO le Thibelo le Taolo ea Tetanus ea Leqeba Tlhokomelong ea Tšohanyetso.
• Setsi sa Tšireletso ea Bophelo bo Botle sa UK (UKHSA, United Kingdom): Ho Entoa Khahlanong le Mafu a Tšoaetso (Buka e Tala, Khaolo ea 30: Tetanus: Taolo ea Maqeba a Tetanus).
• American College of Foot and Ankle Surgeons (ACFAS, United States): *Tlhaloso ea Tumellano ea Kliniki: Tlhahlobo le Kalafo ea Maqeba a ho Hlatsoa ha Plantar le Pseudomonas Osteochondritis *.
• Infectious Diseases Society of America (IDSA, United States): Itloaetse Tataiso bakeng sa Tlhahlobo le Tsamaiso ea Letlalo le Mafu a Bonolo a Tissue.

Litataiso tse amanang¶

• Ho thakhisoa le ho tsitsisa ntho e tsoang kantle ho naha
• Maqeba, mekhoro le tlhokomelo e nyane ea maqeba
• Ho longoa ke liphoofolo: ho longoa ke lintja, ho loma katse, le tlhokomelo ea tšoaetso ea maqeba
• Taolo e matla ea mali le li-tourniquets
• Ho lemoha sepsis le septic shock
• Linomoro tsa maemo a tshohanyetso ho ea ka linaha