Acute tetanus: Difference between revisions
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== | ==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 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 | |||
==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 | |||
hypocalcemic tetany | #PTA | ||
#teritonitis. SAN | |||
#meningitis | |||
#rabies | |||
#TMJ | |||
==Treatment== | ==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 | |||
[[Category:ID]] | [[Category:ID]] |
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 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
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