26. TETANUS Flashcards
Recovery
After 4 to 6 weeks, toxins are degraded and recovery from spasms depend on the regrowth of the axon nerve terminals
Diagnosis
Culture
Serium anti-tetanus IgG
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
How to manage Tetanus???
ICU patients ang mga may Tetano
- Respiratory
- Immuoglobulin + Toxoid
- Wound debridement and Antibiotics
- Muscle Spasms
- ANS Dysfunction management
- PT
- Immunization
- Respiratory Mgt for Tetanus
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
- TETANUS IMMUNOGLOBULIN and TOXOID
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
Why give immunoglobulin and toxoid first?
It is important that TIG be given before wound debridement because to prevent further spread of exotoxin when wound is manipulated in debridement
Dosage of Immunoglobulin?
3000 to 5000 IU of Human Tetanus Ig
Preferred antibiotic for tetanus
METRONIDAZOLE 500 mg/IV q6
- Control of muscle spasms
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.
- Management of Autonomic Dysfunction
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
- Immunization 0 patients who recover from tetanus should receive active immunization since tetanus toxin is _____________ thus, previous infection does not confer immunity
- Immunization 0 patients who recover from tetanus should receive active immunization since tetanus toxin is weakly immunogenic, thus, previous infection does not confer immunity
WHO guidelines for tetanus vaccination consist of:
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
Common tetanus prone wounds:
Wounds >6h old without good wound care Puncture or crush wounds Avulsions/Fractures Burns Frostbite
