24. Tetanus

Question 1

Tetanus CF

Answer 1

nervous system disorder 
characterized by muscle spasms 
that is caused by the 
toxin-producing anaerobe 
Clostridium tetani, 
which is found in the soil

Question 2

Pathophysiology

Answer 2

Clostridium tetani
Anaerobic gram -ve
produces potent Toxin

Passage soil / dust / animal / human faeces
Contamination by bacterials spores
open wound abrasina

Entry to body
Bacillus
realease tetanospasmin
cleaves 
synaptobrevin
(membrane protein for NT rel)

NT release from pre synaptic GABAergic glycinergic inhibitory interneurons inhibited

Untrcontrolled motor neuro activity
increased muscle tone / spasm
uninhibited sympatheic nervous system
=CVS instability

Disease course prolonged irreversible neuronal binding of neurotoxin

Question 3

Exam

clinical features

Answer 3

Trismus
Provoked placing wooden spatula in mouth

Facial muscle spasm
risus sardonicus

Truncal muscle spasm
Opishotomus

Presence open wound - passage infection

Question 4

Exam

Serious adverse

Answer 4

Airway & resp compromise
laryngospasm may be fatal

Autonomic storm
-tachycardia / hypertenson/sweating/pyrexia/period brady hypotension
= asystole

Question 5

Management

A

Answer 5

Transfer to HDU / ICU
ideal dark side room

Airway - If compromise
semi elective intubation and ventilation
*laryngoscopy may cause spasm

Early trache to aid prolong wean

Question 6

Mx

Spasm control

Answer 6

High dose IV benzodiazepine
- high dose diaz/midaz

10 to 30 mg IV and repeated as needed every 1 to 4 hours

NMBA if severe resistant to bzd

Mg sulfate
clonidine atropine
cvs stability

Question 7

Specific Rx

Answer 7

Human tetanus immunoglobulin infusion
5000-10000 u
1 dose

Tetanus anti toxin s/c admin

Immunisation w/ toxoid

Wash/surgical debridement open wound

Consider abx if evidence of wound infection

Question 8

ICU Mx

Answer 8

MDT

Enteral feeding

Ventilator care bundles

VTE proph

Monitor for rhabdo