Acute tetanus

General

- 45% mortality

- 2 to 56d incubation period

- if pt survives, no residual sequealae

- 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

- 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 however

-steroids & hyperbaric O2- no evidence

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 TETANUS

- 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

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