Acute tetanus: Difference between revisions
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==Types== | ==Types== | ||
=== | ===Neonatal=== | ||
# from umbilical stump infection. Usually protected by passive maternal Abs | # from umbilical stump infection. Usually protected by passive maternal Abs | ||
# sx- poor suck, irritability, crying, grimacing | # sx- poor suck, irritability, crying, grimacing | ||
# usually with in 10 d of birth | # usually with in 10 d of birth | ||
=== | ===Local=== | ||
#rigidity of muscles near wound- may progress to generalized | #rigidity of muscles near wound- may progress to generalized | ||
=== | ===Generalized=== | ||
# most common form | # most common form | ||
# pts are conscious and alert | # pts are conscious and alert | ||
# hypersympathetic state c sweating, HTN, tachycardia, fever | # hypersympathetic state c sweating, HTN, tachycardia, fever | ||
=== | ===Cephalic=== | ||
# folloew injuries to head or otitis media | # folloew injuries to head or otitis media | ||
# get CN dysfnction- usually CN 7 | # get CN dysfnction- usually CN 7 | ||
Revision as of 05:32, 28 March 2011
Background
- 45% mortality
- 2 to 56d incubation period
- if pt survives, no residual sequealae
Types
Neonatal
- from umbilical stump infection. Usually protected by passive maternal Abs
- sx- poor suck, irritability, crying, grimacing
- usually with in 10 d of birth
Local
- rigidity of muscles near wound- may progress to generalized
Generalized
- most common form
- pts are conscious and alert
- hypersympathetic state c sweating, HTN, tachycardia, fever
Cephalic
- folloew injuries to head or otitis media
- get CN dysfnction- usually CN 7
Diagnosis
- sxs for 2 wks- pain & stiffness of jaw, abd, back, diff swallowing, hyperactive DTRs, labile HTN,
- DX = clinical
DDx
- dystonic rxn
- strychnine
- hypocalcemic tetany
- PTA
- teritonitis. SAN
- meningitis
- rabies
- TMJ
Treatment
- wound debridement
- TIG- 3000- 10K IM- prevents additional dz but does not reverse toxin already fixed to CNS. Binds circulating toxin
- IVF/ hyperal
- quiet room
- sedation c phenobarb, valium or paralytics
- ABx- pen G or flagyl- not 100% proven
steroids & hyperbaric O2 = no evidence