Acute tetanus: Difference between revisions

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

Authors:

@@ Line 1: / Line 1: @@
-==General==
+==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
-- 45% mortality
+===LOCAL===
+#rigidity of muscles near wound- may progress to generalized
-- 2 to 56d incubation period
+===GENERALIZED TETANUS===
+# most common form
+# pts are conscious and alert
+# hypersympathetic state c sweating, HTN, tachycardia, fever
-- if pt survives, no residual sequealae
+===CEPHALIC===
+# folloew injuries to head or otitis media
+# get CN dysfnction- usually CN 7
-- sxs for 2 wks- pain & stiffness of jaw, abd, back, diff swallowing, hyperactive DTRs, labile HTN,
+==Diagnosis==
+# sxs for 2 wks- pain & stiffness of jaw, abd, back, diff swallowing, hyperactive DTRs, labile HTN,
+# DX = clinical
-- DX = clinical
+==DDx==
+#dystonic rxn
-- DDx- dystonic rxn, strychnine
+#strychnine
+#hypocalcemic tetany
-hypocalcemic tetany, PTA, teritonitis. SAN, meningitis, rabies, TMJ
+#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
-- 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
-==Types of Tetanus==
-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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