26. TETANUS

Question 1

Recovery

Answer 1

After 4 to 6 weeks, toxins are degraded and recovery from spasms depend on the regrowth of the axon nerve terminals

Question 2

Diagnosis

Culture
Serium anti-tetanus IgG

Answer 2

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

Question 3

How to manage Tetanus???

Answer 3

ICU patients ang mga may Tetano

1. Respiratory
2. Immuoglobulin + Toxoid
3. Wound debridement and Antibiotics
4. Muscle Spasms
5. ANS Dysfunction management
6. PT
7. Immunization

Question 4

1. Respiratory Mgt for Tetanus

Answer 4

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

Question 5

2. TETANUS IMMUNOGLOBULIN and TOXOID

Answer 5

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

Question 6

Why give immunoglobulin and toxoid first?

Answer 6

It is important that TIG be given before wound debridement because to prevent further spread of exotoxin when wound is manipulated in debridement

Question 7

Dosage of Immunoglobulin?

Answer 7

3000 to 5000 IU of Human Tetanus Ig

Question 8

Preferred antibiotic for tetanus

Answer 8

METRONIDAZOLE 500 mg/IV q6

Question 9

4. Control of muscle spasms

Answer 9

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.

Question 10

5. Management of Autonomic Dysfunction

Answer 10

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

Question 11

7. Immunization 0 patients who recover from tetanus should receive active immunization since tetanus toxin is _____________ thus, previous infection does not confer immunity

Answer 11

7. Immunization 0 patients who recover from tetanus should receive active immunization since tetanus toxin is weakly immunogenic, thus, previous infection does not confer immunity

Question 12

WHO guidelines for tetanus vaccination consist of:

Answer 12

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

Question 13

Common tetanus prone wounds:

Answer 13

Wounds >6h old without good wound care
Puncture or crush wounds
Avulsions/Fractures
Burns
Frostbite