TETANUS Flashcards
Cause of tetanus
Clostridium tetani
Habitat of C. tetani
Soil
Tetanus-prone wounds
Burns
Puncture injuries
Wounds contaminated by soild/manure
Septic wounds
Wounds with much devitalized tissue
Compound fractures
Incubation period of C. tetani
3-21 days
Symptoms of tetanus
Difficulty or inability to open mouth
Constipation
Stiff body
Spasms
Triggers for spasms in tetanus
noise
bright light
touch
Treatment objectives in tetanus
To prevent further spasms
To eliminate Clostridium tetani to stop further toxin production
To neutralise circulating toxin
To provide adequate hydration and nutrition
To provide supportive care till spasms cease completely
Signs of tetanus
Umbilicus may be infected
Presence of wound (but may have healed)
Irritability
Cyanosis during spasms
Sardonic (mocking) smile
Lock jaw (cannot open the mouth)
Opisthotonus (stiff arched back)
Rigid abdomen and stiff neck and limbs
Non-pharmacological interventions in tetanus
Always admit a suspected case of tetanus
Maintain a clear airway
Avoid noise, bright light and unnecessary physical examination of the patient
Clean the infected umbilicus or wound with soap and water or antiseptic solution
Surgical debridement of the wound when necessary
Antibiotic regimen in a patient diagnosed with tetanus
First line
Metronidazole
Second line
Benzylpenicillin
and
IV Gentamycin in neonates, 4mg/kg 24 hourly
Metronidazole dose in tetanus
Metronidazole, IV,
Adults
500 mg 6 hourly for 7-10 days
Children
> 1 month 7.5 mg/kg 8 hourly for 7-10 day
Neonates
> 7 days; 7.5 mg/kg 12 hourly
< 7 days; 7.5 mg/kg 48 hourly
Dose of benzylpenicillin in tetanus
Benzylpenicillin, IV,
Adults
50,000 units/kg stat, then 4 MU 6 hourly for 5 days
Children
50,000 units/kg 6 hourly for 5 days
Neonates
250,000 units 6 hourly for 7 days
Pharmacological management to neutralise free circulating toxin in tetanus
Human Tetanus Immunoglobulin, IM or IV,
and
Tetanus Toxoid, IM,
Dose of tetanus toxoid
Tetanus Toxoid, IM, (inject at different site from Human Tetanus Immunoglobulin)
Adults and Children
> 2 years; 0.5 ml stat. Repeat at 4-8 weeks (2nd dose) and at
6-12 months (3rd dose)
< 2 years; 3 doses of Pentavalent vaccine at
intervals of four weeks
Dose of human tetanus immunoglobulin
Human Tetanus Immunoglobulin, IM or IV,
Adults and Children
500 units stat.
Neonates
250 units stat.
Dose of chlorpromazine to control spasms in tetanus
Adults
Chlorpromazine, IM, 50 mg 4-8 hourly
Children
Chlorpromazine, IM or oral (via nasogastric tube), 12.5-25 mg 8 hourly
Neonates
Chlorpromazine, IM or oral (via nasogastric tube), 7.5 mg 8 hourly
Treatment of spasms in tetanus
Adults
Chlorpromazine and Diazepam/Phenobarbitone
Children
Chlorpromazine and Diazepam/Phenobarbitone
Neonates
Chlorpromazine and Phenobarbitone, add Diazepam if spasms are not controlled
Dose of diazepam to control spasms in tetanus
Adults
Diazepam, IV or IM, (by slow IV at a rate of not more than 5 mg/minute), 5-10 mg 3-6 hourly when required
Children
Diazepam, IV/IM/nasogastric tube/ suppository, 0.3 mg/kg 3-6 hourly when required (by slow IV at a rate of not more than 5 mg/minute)
Neonates
Diazepam, rectal, 0.5 mg/kg 3-6 hourly when required
Dose of phenobarbitone to control spasms in tetanus
Adults
Phenobarbitone, IM, 200 mg 8-12 hourly, gradually reduce sedation after about 2 weeks
Children
Phenobarbitone, IM or oral (via nasogastric Tube), 10 mg/kg stat., then 2.5 mg/kg 12 hourly
Neonates
Phenobarbital (Phenobarbitone), IM or oral (via nasogastric tube), 30 mg stat. then 7.5 mg 12 hourly
Tetanus infection does not provide immunity against future episodes. T/F
True
When is immunisation for tetanus started
Start Immunisation before discharge from hospital in all patients because tetanus infection does not provide immunity against future episodes
Tetanus immunisation after infection
A course of tetanus toxoid vaccinations should be given to any previously
unimmunised patient older than 2 years of age. Dose: 0.5 ml, IM or deep
SC, repeat at 4 weeks and 8 weeks (primary course)
Previously unimmunised children below the age of 2 years should receive 3 doses of 5 in 1 at intervals of four weeks
How many doses of tetanus vaccine is needed for lifelong immunity
5 doses
When is a booster dose required for tetanus
If 10 or more years (5 or more years for children below age 15 years) have
elapsed since primary course or last booster, give booster dose of 0.5 ml
When is a booster dose required in tetanus prone wounds
A booster dose may be given if more than five years have elapsed since the last dose
Tetanus vaccination for survivors of neonatal tetanus
Normal schedule for “Five in- One” (Penta-) vaccine
Prevention of tetanus in tetanus prone wounds
Adequate wound toileting
Tetanus prophylaxis
