Tetanus

Question 1

T/F

All tetanus spp can cause tetanus infection.

Answer 1

False. Some spp are non-tetanospasmin producing

Question 2

Elderly
Affected are: 
T cell
B cell
Immune cells

Immune senescence affects ????

Answer 2

Yes

Question 3

Skin popping from drug/heroin injection

Answer 3

Wrist
Forearms
Interdigital areas
Under the tongue

(Also check these areas for infective endocarditis)

Question 4

Why can’t cardiac muscle be tetanized?

Answer 4

Long refractory period due to slow calcium channels (L-type)

Question 5

Binding of toxins

Answer 5

Already bound- cannot be removed na (4-6weeks)
Unbound- can still be removed
Give meds to address symptoms

Question 6

Positive spatula test

Answer 6

Normal: gag reflex

Tetanus (+): no gag, involuntary contraction of jaw-> spasm -> biting

Question 7

Why is culture not reliable?

Answer 7

Anaerobic, cannot grow easily

Toxin causes the disease not the bacteria itself

Question 8

Shorter incubation, shorter onset, poorer prognosis

Answer 8

Do early tracheostomy bcos of laryngeal muscle spasms

Question 9

Antibiotic duration

Answer 9

7 days

Question 10

Immunization

How long to stay in hospi

Answer 10

~4-6 weeks

Give antitoxins/ Ig to perform neutralization of the unbound toxins

Question 11

Human tetanus Ig

Answer 11

Less anaphylactic reactions than equine antitoxin

Question 12

Diazepam shorter acting

Why bzd given IV?

Mgmt in ER: Tracheostomy plus NGT
Medications are additive (u do not change the initial med) —> bzd is last to tanggal

Answer 12

But not really often given bcos of propylene glycol—> lactic acidosis

IV bcos:
More rapid action than oral
More titrable and with direct action in the blood

Question 13

High bp mgmt

Scenario for high bp:
Nicardipine- super lowered bp-> discontinue -> start iv fluids
-di pa tumataas bp-> give vasopressors

Answer 13

short acting, rapid onset, easily titrable

• esmolol
• Propranolol
• use iv form

Question 14

complications

Answer 14

Matagal maunbound ang toxin—> prolonged ventilator -> VAP
Upright position- para no aspiration
Central-line infections
Septicemia
Pressure ulcer -reduce pressure in sacral area by side to side lying
Stress ulcer
Thrombophlebitis- from diazepam injection; give LMWH and compression stockings

No prophylactic antibiotics for infection
All preventive

Question 15

Tetanus prophylaxis

Answer 15

Passive- TIG
With Antibodies na: fast action
There is already temporary amnestic response??? (Double check!)
Not immunogenic
Can still receive tetanus containg vax during active infection
Give both active and passive immunization during active infection

Question 16

Immunoglobulin (TIG)

Answer 16

Only dirty wounds (tetanus-prone)
Involvement of:
-Viscera, with soil involved, fecal, burns, fire cracker injuries
-unknown or incomplete vax hx

Question 17

1. Booster on 2018 tapos vehicular accident today (2021), what to give?
   Complete vax hx
2. Unknown vax hx, firecracker injury
3. Nadapa sa poo ng cow, unknown vax
4. Nadapa sa cow poo but With complete vax

Vax administration-when to give

Answer 17

1. No need to give any
2. Dirty wound- give both active and passive
3. Give both
4. No need

0, 1, 6 (sept, oct, march 2022)
-6 mos from sept..