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Tetanus - an acute disease characterised by painful muscular contractions…
Tetanus - an acute disease characterised by painful muscular contractions and spasms.
Airway management
Risk of death from resp.failure
(muscles of resp and /or laryngospasm)
Low threshold for intubation and mechanical ventilation
Early tracheostomy may be indicated
Neutralisation of unbound toxin - Human tetanus immunoglobulin 3000 units IM
Source control and limitation of toxin production
Surgical debridement to reduce the bacterial and toxin load
Antibiotics to eradicate the tetanus bacterium (Flagyl)
Control of muscle spasm and rigidity
Sedation
Benzos first line
Morphine can be used as adjunct
Propofol has been used successfully (to give sufficient concentration - MV required)
Intrathecal baclofen has been used
NMB if refractory
Avoid stimulation (can provoke)
Manage Autonomic dysfunction
Severe tetanus is associated with 'autonomic storms' with raised catecholamine levels, alternating with episodes of hypotension and bradycardia
Options
Sedation (first line)
B Blockade - useful for HTN and tachy but is associated with APO
Clonidine
MgSO4: decreases autonomic hyperactivity and useful adjunct in controlling muscle spasms and rigidity
Immunisation
Recovery from tetanus does not result in immunity
Immunisation with tetanus toxoid (with diptheria and pertusis) at site separate from TIG injection