Acute tetanus

Background

1. 45% mortality
2. 2 to 56d incubation period
3. if pt survives, no residual sequealae

Types

Neonatal

1. from umbilical stump infection. Usually protected by passive maternal Abs
2. sx- poor suck, irritability, crying, grimacing
3. usually with in 10 d of birth

Local

1. rigidity of muscles near wound- may progress to generalized

Generalized

1. most common form
2. pts are conscious and alert
3. hypersympathetic state c sweating, HTN, tachycardia, fever

Cephalic

1. follow injuries to head or otitis media
2. get CN dysfunction- usually CN 7

Diagnosis

1. sxs for 2 wks- pain & stiffness of jaw, abd, back, diff swallowing, hyperactive DTRs, labile HTN,
2. DX = clinical

DDx

1. dystonic rxn
2. strychnine
3. hypocalcemic tetany
4. PTA
5. teritonitis. SAN
6. meningitis
7. rabies
8. TMJ

Treatment

1. wound debridement
2. TIG- 3000- 10K IM- prevents additional dz but does not reverse toxin already fixed to CNS. Binds circulating toxin
3. IVF/ hyperal
4. quiet room
5. sedation with phenobarb, valium or paralytics
6. ABx- pen G or flagyl- not 100% proven

steroids & hyperbaric O2 = no evidence