Chapter 157: Tetanus

Question 1

toxin responsible for all the clinical manifestations of tetanus

Answer 1

Tetanospasmin (does not cross the BBB)
- Tetanospasmin prevents the release of the inhibitory neurotransmitters glycine and y-aminobutyric acid from presynaptic nerve terminals

*tetanolysin - facilitates growth of the bacterial population

Question 2

TRUE or FALSE: mental status in tetanus is altered

Answer 2

FALSE: mental status is normal, an important consideration in differentiating tetanus from other disorders

Question 3

Three forms of tetanus:

Answer 3

• generalized
• cephalic: follows head injury; CN VII most commonly affected; poor prognosis
• local: proximity to the site; resolves completely after weeks to months

Question 4

Strychnine poisoning mimics what form of tetanus

Answer 4

Generalized

Question 5

True or False: Tetanus provides immunity

Answer 5

FALSE

Question 6

TRUE or FALSE: neuromuscular blockade is CI in tetanus

Answer 6

FALSE: Respiratory compromise requires immediate neuromuscular blockade and intubation

Question 7

General treatment for Tetanus

Answer 7

• Supportive
• Wound debridement
• Immunization
  *immunoglobulin given before wound debridement
• airway protection
• minimize environmental stimuli

Question 8

post exposure prophylaxis in tetanus

Answer 8

single dose of 250 units (4 units/kg in children) IM given in the anterolateral thigh or deltoid is recommended

Question 9

optimal dose of tetanus immunoglobulin for treatement

Answer 9

3000 to 6000 units IM

*administered in a separate syringe and opposite the site of tetanus toxoid administration

Question 10

Antibiotic used for tetanus

Answer 10

metronidazole, 500 milligrams IV every 6 to 8 hours

Question 11

prefered muscle relaxant for tetanus

Answer 11

benzodiazepines - DIAZEPAM
MIDAZOLAM - continuous infusion if larger doses needed

Question 12

treatment for autonomic dysfunction

Answer 12

Magnesium sulfate

options: esmolol, labetalol, morphine, clonidine

Question 13

Tetanus immunization

Answer 13

• Give adsorbed tetanus toxoid (0.5 mL) IM at the time of presentation and at 6 weeks and 6 months after injury
• tetanus-diphtheria if more than or equal to 7 years old
• ## (DTaP) for patients <7 years of age

Question 14

optimal timing for Tdap administration in pregnancy

Answer 14

27 and 36 weeks

Question 15

Exaggerated local reactions following tetanus immunization

Answer 15

Arthus reactions

Question 16

contraindications to TD or Tdap

Answer 16

• serious allergic reaction vaccine components
• History of encephalopathy not attributable to an identifiable cause within 7 days of administration of a pertussis vaccine is a contraindication to Tdap

Question 17

defer TD or Tdap

Answer 17

• Guillain-Barré syndrome
• less than or equal to 6 weeks after a previous dose of tetanus toxoid-containing vaccine
• moderate to severe acute illness
• unstable neurologic condition
• history of an Arthus reaction to a tetanus toxoid–containing vaccine
• administered <10 years previously