Acute tetanus - Revision history

NoahBeggs: /* Management */ Literally just added a / in the to fix ref error

2025-03-19T22:59:23Z

Management: Literally just added a / in the </ref> to fix ref error

← Older revision		Revision as of 22:59, 19 March 2025
Line 56:		Line 56:
	**Does not reverse toxin already bound to CNS. Binds circulating toxin		**Does not reverse toxin already bound to CNS. Binds circulating toxin
	*Tetanus toxoid; patients do NOT develop immunity after tetanus infection		*Tetanus toxoid; patients do NOT develop immunity after tetanus infection
	**Give during convalescence, not at initial presentation.<ref>https://www.cdc.gov/tetanus/clinicians.html#symptoms<ref>		**Give during convalescence, not at initial presentation.<ref>https://www.cdc.gov/tetanus/clinicians.html#symptoms</ref>
	===Supportive Care===		===Supportive Care===
	*Place patient in a quiet room		*Place patient in a quiet room

Erdojjones: /* Management */

2022-10-10T20:04:00Z

Management

← Older revision		Revision as of 20:04, 10 October 2022
Line 56:		Line 56:
	**Does not reverse toxin already bound to CNS. Binds circulating toxin		**Does not reverse toxin already bound to CNS. Binds circulating toxin
	*Tetanus toxoid; patients do NOT develop immunity after tetanus infection		*Tetanus toxoid; patients do NOT develop immunity after tetanus infection
			**Give during convalescence, not at initial presentation.<ref>https://www.cdc.gov/tetanus/clinicians.html#symptoms<ref>
	===Supportive Care===		===Supportive Care===
	*Place patient in a quiet room		*Place patient in a quiet room

Elcatracho: /* Clinical Features */

2021-03-08T20:10:20Z

Clinical Features

← Older revision		Revision as of 20:10, 8 March 2021
Line 11:		Line 11:

	==Clinical Features==		==Clinical Features==
			[[File:Opisthotonus_in_a_patient_suffering_from_tetanus_-_Painting_by_Sir_Charles_Bell_-_1809.jpg\|thumb\|Opisthotonus in a patient suffering from tetanus]]
	===Neonatal===		===Neonatal===
	*From umbilical stump infection. Usually protected by passive maternal Abs		*From umbilical stump infection. Usually protected by passive maternal Abs

Elcatracho: /* See Also */

2021-03-08T20:07:43Z

Josgood: /* Generalized */

2020-08-15T18:12:34Z

Generalized

← Older revision		Revision as of 18:12, 15 August 2020
Line 23:		Line 23:
	*Usually begins with trismus (spasm of the masticator muscle group) with gradual onset of spasm of muscle groups in the trunk and extremities		*Usually begins with trismus (spasm of the masticator muscle group) with gradual onset of spasm of muscle groups in the trunk and extremities
	*Spasms exacerbated by external stimuli (light or sudden sound)		*Spasms exacerbated by external stimuli (light or sudden sound)
	*Patients can lose ability to ~~breath~~ during prolonged spasms		*Patients can lose ability to breathe during prolonged spasms
	*Respiratory failure is main cause of death		*Respiratory failure is main cause of death
	*Patients are conscious and alert		*Patients are conscious and alert

Leahburch: /* Background */

2018-04-27T23:58:24Z

Background

← Older revision		Revision as of 23:58, 27 April 2018
Line 1:		Line 1:
	==Background==		==Background==
	*C. tetani spores enter skin through wound, make tetanospasmin toxin		*''Clostridium tetani'' spores enter skin through wound, make tetanospasmin toxin
	**Lacerations, abrasions, puncture wounds
	**Preferentially binds GABA and glycinergic neurons and blocks pre-synaptic release
	***Motor neurons undergo sustained excitatory discharge
	*Spores found in soil and human feces
	*2001-2008 in US, 233 cases, 26 deaths		*2001-2008 in US, 233 cases, 26 deaths
	*Mortality as high as 45%		*Mortality as high as 45%
	*Incubation is 2 to 56d		*Incubation is 2 to 56d
			*Spores found in soil and human and animal feces
			**Tetanus prone wounds include contaminated lacerations, abrasions, puncture wounds; crush, avulsion, or frostbite injuries are also vulnerable to tetanus <ref>Auerbach PS. Wilderness Medicine. Philadelphia: Mosby Elsevier; 2007.</ref>
			**Preferentially binds GABA and glycinergic neurons and blocks pre-synaptic release
			***Motor neurons undergo sustained excitatory discharge, producing spasms
	*The majority of clinical tetanus happen in the elderly.<ref>Talan DA, et al. Tetanus immunity and physician compliance with tetanus prophylaxis practices among emergency department patients presenting with wounds. Ann Emerg Med. 2004 Mar;43(3):305-14.[http://www.ncbi.nlm.nih.gov/pubmed/14985655 Pubmed]</ref>		*The majority of clinical tetanus happen in the elderly.<ref>Talan DA, et al. Tetanus immunity and physician compliance with tetanus prophylaxis practices among emergency department patients presenting with wounds. Ann Emerg Med. 2004 Mar;43(3):305-14.[http://www.ncbi.nlm.nih.gov/pubmed/14985655 Pubmed]</ref>

Line 13:		Line 13:
	===Neonatal===		===Neonatal===
	*From umbilical stump infection. Usually protected by passive maternal Abs		*From umbilical stump infection. Usually protected by passive maternal Abs
	*Symptoms - poor suck, irritability, crying, grimacing		*Symptoms - poor suck and failure to nurse, irritability, crying, grimacing
	*Usually with in 10 d of birth		*Usually with in 10 d of birth

Line 20:		Line 20:

	===Generalized===		===Generalized===
	*Most common form		*Most common form of tetanus
	*~~PTs~~ are conscious and alert		*Usually begins with trismus (spasm of the masticator muscle group) with gradual onset of spasm of muscle groups in the trunk and extremities
			*Spasms exacerbated by external stimuli (light or sudden sound)
			*Patients can lose ability to breath during prolonged spasms
			*Respiratory failure is main cause of death
			*Patients are conscious and alert
	*Hypersympathetic state with sweating, hypertension, tachycardia, fever		*Hypersympathetic state with sweating, hypertension, tachycardia, fever

Line 38:		Line 42:
	**Sardonic smile (risus sardonicus) - other facial muscles become involved		**Sardonic smile (risus sardonicus) - other facial muscles become involved
	**Minor stimuli such as touch or noise start tetanic contractions		**Minor stimuli such as touch or noise start tetanic contractions
	**~~Abd, back, diff~~ swallowing		**Difficulty swallowing
	**Long bone fractures, tendon rupture		**Long bone fractures, tendon rupture
	**Opisthotonus - ~~contractures that resemble decorticate posturing~~		**Opisthotonus - lumbar lordosis with the neck and legs extended and the arms flexed at the elbows
			**Laryngospasm
			**Autonomic instability
			**Sympathetic nervous system hyperactivity, including tachycardia, sweating, arrhythmias, and hypertension
			*No laboratory testing is used to diagnose tetanus; wound cultures are often negative

	==Management==		==Management==
Line 46:		Line 54:
	**Dose: 3000-6000 units IM with adequate mL to wound		**Dose: 3000-6000 units IM with adequate mL to wound
	**Does not reverse toxin already bound to CNS. Binds circulating toxin		**Does not reverse toxin already bound to CNS. Binds circulating toxin
	*Tetanus toxoid		*Tetanus toxoid; patients do NOT develop immunity after tetanus infection
	===Supportive Care===		===Supportive Care===
	*Place patient in a quiet room		*Place patient in a quiet room
	*Provide sedation with [[Benzodiazepines]] or phenobarbital		*Provide sedation with [[Benzodiazepines]] or phenobarbital
	*~~Respiratory~~ management		*Airway management via intubation or tracheostomy should be performed when patient exhibits dysphagia or respiratory difficulties
	*Autonomic dysfunction management with magnesium sulfate or labetalol, morphine and clonidine		*Autonomic dysfunction management with magnesium sulfate or labetalol, morphine and clonidine
			*Magnesium sulfate has several desirable attributes for control of spasticity and autonomic dysfunction in tetanus<ref>Wangmo KP, Teng M, Henker R, Kinnear S, Tshering J, Wang NE. Survival of a Patient With Tetanus in Bhutan Using a Magnesium Infusion Managed Only by Clinical Signs. Wilderness & Environmental Medicine. 2014;25(2):194-197. doi:10.1016/j.wem.2013.11.006.</ref>
			**Acts as a presynaptic neuromuscular blocker by antagonizing calcium in the neuromuscular junction and myocardium
			**Blocks the release of catecholamines and has anticonvulsant properties
			**Often available in low-resource settings

	===[[Antibiotics]]===		===[[Antibiotics]]===
Line 63:		Line 75:
	<references/>		<references/>
	Moll JL, Carden DL. Tetanus. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016. http://accessmedicine.mhmedical.com/content.aspx?bookid=1658&sectionid=109435736. Accessed December 01, 2017.		Moll JL, Carden DL. Tetanus. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016. http://accessmedicine.mhmedical.com/content.aspx?bookid=1658&sectionid=109435736. Accessed December 01, 2017.


	[[Category:ID]]		[[Category:ID]]

Iwm5010: /* References */

2017-12-01T22:17:55Z

References

← Older revision		Revision as of 22:17, 1 December 2017
Line 62:		Line 62:
	==References==		==References==
	<references/>		<references/>
			Moll JL, Carden DL. Tetanus. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016. http://accessmedicine.mhmedical.com/content.aspx?bookid=1658&sectionid=109435736. Accessed December 01, 2017.
	[[Category:ID]]		[[Category:ID]]

Iwm5010: /* Supportive Care */

2017-12-01T22:17:28Z

Supportive Care

← Older revision		Revision as of 22:17, 1 December 2017
Line 51:		Line 51:
	*Provide sedation with [[Benzodiazepines]] or phenobarbital		*Provide sedation with [[Benzodiazepines]] or phenobarbital
	*Respiratory management		*Respiratory management
			*Autonomic dysfunction management with magnesium sulfate or labetalol, morphine and clonidine

	===[[Antibiotics]]===		===[[Antibiotics]]===
	{{Tetanus Antibiotics}}		{{Tetanus Antibiotics}}

Iwm5010: /* Management */

2017-12-01T22:15:52Z

Management

← Older revision		Revision as of 22:15, 1 December 2017
Line 43:		Line 43:

	==Management==		==Management==
	*Before wound debridement, ~~apply~~ immunoglobulin (TIG) directly into the wound and IM		*Before wound debridement, immunoglobulin (TIG) directly into the wound and IM
	**Dose: 3000-6000 units IM with adequate mL to wound		**Dose: 3000-6000 units IM with adequate mL to wound
	**~~Des~~ not reverse toxin already ~~fixed~~ to CNS. Binds circulating toxin		**Does not reverse toxin already bound to CNS. Binds circulating toxin
			*Tetanus toxoid
	===Supportive Care===		===Supportive Care===
	*Place patient in a quiet room		*Place patient in a quiet room
	*Provide sedation with [[Benzodiazepines]] or phenobarbital		*Provide sedation with [[Benzodiazepines]] or phenobarbital
			*Respiratory management
	===[[Antibiotics]]===		===[[Antibiotics]]===
	{{Tetanus Antibiotics}}		{{Tetanus Antibiotics}}

Iwm5010: /* Background */

2017-12-01T22:12:34Z

Background

← Older revision		Revision as of 22:12, 1 December 2017
Line 1:		Line 1:
	==Background==		==Background==
	*C. tetani spores enter skin through wound, make tetanospasmin toxin		*C. tetani spores enter skin through wound, make tetanospasmin toxin
	**~~Lacs~~, abrasions, puncture wounds		**Lacerations, abrasions, puncture wounds
	**Preferentially binds GABA and glycinergic neurons and blocks ~~presynaptic~~ release		**Preferentially binds GABA and glycinergic neurons and blocks pre-synaptic release
	***Motor neurons undergo sustained excitatory discharge		***Motor neurons undergo sustained excitatory discharge
	*Spores found in soil and human feces		*Spores found in soil and human feces

← Older revision		Revision as of 20:07, 8 March 2021
Line 71:		Line 71:
	*[[Tetanus (Prophylaxis)]]		*[[Tetanus (Prophylaxis)]]
	*[[Clostridium]]		*[[Clostridium]]
			*[[Vaccination schedule]]

	==References==		==References==