26. TETANUS Flashcards

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1
Q

Recovery

A

After 4 to 6 weeks, toxins are degraded and recovery from spasms depend on the regrowth of the axon nerve terminals

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2
Q

Diagnosis

Culture
Serium anti-tetanus IgG

A

Culture of clostridium tetani from a wound only provides supportive evidence because not all strains exhibit the toxin.**

Also, C. Tetani may be present in the wound in the absence of clinical disease

Serum anti-tetanus IgG before antitoxin administration may rule out suspected tetanus because serum levels >0.1 IV/mL are deemed protective and do not support the diagnosis of tetanus

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3
Q

How to manage Tetanus???

A

ICU patients ang mga may Tetano

  1. Respiratory
  2. Immuoglobulin + Toxoid
  3. Wound debridement and Antibiotics
  4. Muscle Spasms
  5. ANS Dysfunction management
  6. PT
  7. Immunization
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4
Q
  1. Respiratory Mgt for Tetanus
A

It is important to establish SECURE AIRWAY early in tetanus

Patients must be given SUCCINYLCHOLINE (Neuromuscular blockers) and INTUBATION and MECH VENT

TRACHEOSTOMY IF HINDI KAYA

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5
Q
  1. TETANUS IMMUNOGLOBULIN and TOXOID
A

3000 to 5000 IV of Human tetanus Ig (TIG a portion of which should be injected around the wound.

Tetanus toxoid must also be given opposite the site of the TIG.

**It is important that TIG be given before wound debridement because to prevent further spread of exotoxin when wound is manipulated in debridement

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6
Q

Why give immunoglobulin and toxoid first?

A

It is important that TIG be given before wound debridement because to prevent further spread of exotoxin when wound is manipulated in debridement

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7
Q

Dosage of Immunoglobulin?

A

3000 to 5000 IU of Human Tetanus Ig

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8
Q

Preferred antibiotic for tetanus

A

METRONIDAZOLE 500 mg/IV q6

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9
Q
  1. Control of muscle spasms
A

Diazepam 10-30 mg IV q1-4 PRN’

when higher doses of IV Diazepam are used, its vehicle, Propylene glycol may produce hyperosmolarity and a high anion gap metabolic acidosis.

To avoid this problem, continuous infusion with IV Midazolam may be given as it does not require propylene glycol as vehicle d/t its water solubility.

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10
Q
  1. Management of Autonomic Dysfunction
A

For autonomic instability such as labile BP,
Labetalol 0.25-1.9 mg/min has been frequently administered because of its dual a and B-blocking properties both alpha and beta iniinhibit

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11
Q
  1. Immunization 0 patients who recover from tetanus should receive active immunization since tetanus toxin is _____________ thus, previous infection does not confer immunity
A
  1. Immunization 0 patients who recover from tetanus should receive active immunization since tetanus toxin is weakly immunogenic, thus, previous infection does not confer immunity
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12
Q

WHO guidelines for tetanus vaccination consist of:

A

Primary Course of 3 doses in infancy (DTaP x3)
Booster at 4 to 7 yrs old
Booster at 12 to 15 yrs old (Tdap x1)
Booster in adulthood

Individuals sustaining tetanus-prone wounds should be actively immunized if the vaccination status is: incomplete, unknown/unrecalled/last booster was given >10 years ago

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13
Q

Common tetanus prone wounds:

A
Wounds >6h old without good wound care
Puncture or crush wounds
Avulsions/Fractures
Burns
Frostbite
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