23 male pt. brought into the ER by brother. Pt is demonstrating severe face and arm muscle spasms. Pt can hardly talk, trying to get info from the brother. I noted that Pt has many tattoos, including a fresh one on his shoulder. Brother says he got it done yesterday and the tattoo parlor was "sketchy." Ordered blood test, came back positive for Clostridium tetani. Pt has never been vaccinated against this bacteria.

Downstream

Respiratory

Lungs

Lung infection

Breathing in foreign materials

Aspiration

Pneumonia

Difficulty breathing

Death

Blockage of main artery of lung

Blood clot

Pulmonary embolism

Restricted blood flow

Decrease oxygen level

Difficulty breathing

Death

Spasms due to vocal cords

laryngospasms

Struggling to inhale

Airway is blocked

Difficulty breathing & talking& swallowing

Spasms in muscles that control breathing

Bronchospasms

Constriction of muscles in bronchioles

Decreased airflow

Difficulty breathing

Death

Cardiovascular

Heart

Increase blood pressure

Death

Increase heart rate

Bradyarrhythias

Cardiac arrest

Death

Lymphatic

Lymphatic vessels

Enters the lymphatic vessels through deep wounds or contaminated needles.

Nervous

Muscular system

Skeletal System

Central Nervous System

Brain

Spinal Cord

Seizures

Blocks nerve signal

Spinal cord spasms

Causing infection in the blood

Death

Masseter muscle

Severe muscle spasms

"Lockjaw"

Skeletal muscle

Severe muscle spasms

Tear muscles

Opisthotonos

Difficulty talking

Humerous, radius, and ulna

Muscle Spasm

Swelling

Death

Fracture

Upstream

Direct: Tetanus neurotoxin binds to the presynaptic membrane of the neuromuscular junction. This toxin is a poison that blocks neurotransmitter release from spinal cord to muscles, which can lead to severe muscle spasms.

Indirect: Pt got tattoo at a "sketchy" tattoo parlor.

Indirect: Pt was not vaccinated against the bacterium.

Background

Organ systems

Respiratory system

Lungs

Pleural cavity

Thoracic cavity

Cardiovascular system

Heart

Pericardium

Lymphatic system

Lymphatic vessels

Nervous system

Central Nervous System

Brain

Spinal cord

Skull

Posterior Region of body

Cervical Spine

Thoracic Spine

Lumbar spine

Spaces between cells throughout the body

Muscular system

Masseter muscles

Skeletal muscles

Posterior region

Jaw muscle

Jaw

Paralysis

Lumbar spine

Thoracic spine

Neurons

Unipolar nervous

Bipolar neurons

Multipolar neurons

Single process

Divides two branches

One branch to CNS

Periphery branch

end of Spinal cord

Skin

Joints

Muscles

internal organs

Two process

Single axons

Single dendrites

Sense organs

Retina of the eye

Olfactory cells

Multi process

One axon

Many dendrites

In CNS

Brain

Spinal card

Face

Thoracic cavity

Physiology

Organ system

Respiratory system

Lungs

Breathing

Cardiovascular

Heart

Blood circulation

Lymphatic system

Lymphatic vessels

Blood production, maintenance of fluid balance, and defense against disease

Nervous system

Spinal cord

Brain

Provide structural support and balance

Communication between and coordination of all the body systems

Muscular system

Skeletal muscle

Masseter muscle

Spine

Spine

Supports body, facilitates movement, & protects internal organs.

Jaw

Muscle that helps to pull the lower jaw upward, which causes the jaws to close while chewing.

Skeletal system

Humerous, Radius, Ulna

Movement

Support

Chewing

Neurons

Unipolar

Bipolar

Multipolar

Sensory neuron

Afferent neuron

Collects information from receptors

Sends info to CNS

Sends info Periphery branch

Sensory neuron

Interneurons

Process the information & predict the right response.

CNS

Help react to external stimuli.

Motor neuron

Efferent neuron

Send directions for the right response.

Involuntary & voluntary movement

Presynaptic neuron

Postsynaptic neuron

Presynaptic neuron

Presynaptic neuron

Excitatory postsynaptic potentials

Inhibitory postsynaptic potentials

Depolarization of postsynaptic membrane potential

Neurotransmitters opens chemically gated ion channels

Na+ enters cell & K+ outside cell

Positively charged ions into the postsynaptic cell

Allows to send message

Fire action potential

Hyperpolarize of postsynaptic membrane potential

Negatively charged ion into the postsynaptic cell

Neurotransmitter GABA opens chemically gated ion channels

Cl- ion inside the cell or K+ ion outside the cell

Don't Fire

No action potential

ESPSs brings neuron closer to threshold s

IPSPs drive neuron away from threshold (goes down)

Clostridium Tetani

Tetanospasmin

Binds to presynaptic terminal

Retrograde axonal transport to CNS inhibitory interneurons

Transcytosis from axon to inhibitory interneurons

Blockage of neurotransmitters GABA ( inhibit motor neurons)

Blocking GABA causes violent spams

Excitatory transmitters are consistently being released.

Excitation- Contraction Coupling

An action potential arrives at the axon terminal and voltage-gated Ca2+ channels open causing an influx of Ca2+ into the axon terminal.

The influx of Ca2+ into axon terminal causes the exocytosis of ACh into the synaptic cleft.

ACh then binds to receptors on the motor end plate (of muscle cell). If the end plate reaches threshold, an action potential is propagated on the sarcolemma and down the T tubules

Causes depolarization of the T tubules and causes the release of Ca2+ from the terminal cisternae of the sarcoplasmic reticulum.

Movement of Ca2+ into the muscle cell causes Ca2+ to bind to troponin, which moves tropomyosin, exposing the myosin-binding active sites on G actin.

Myosin heads then form cross bridges to the G actin and immediately pivot toward the M line causing chemically activated muscle contraction.

ATP binds to myosin heads, causing them to release muscle contraction and recock.

Summation

Temporal summation

Spatial summation

One presynaptic neurone releases neurotransmitter many times over a period of time.

Higher the frequency of the action potential the more quickly the threshold may be exceeded.

Multiple presynaptic neurones together release enough neurotransmitter (ACh) to exceed the threshold of the postsynaptic neuron.

Threshold may be exceeded and an action potential generated.

Summation brings the axon's initial segment to threshold and AP fires.

Pain

Paralysis

Humerous, radius and ulna

Upper arm

Lower arm

Spine

The temporal summation occurs when the presynaptic action potentials occur in quick succession.

The time frame is dependent upon the passive properties of the membrane, specifically the time constant.

A single action potential in sensory neuron 1 produces a 1-mV EPSP in the motor neuron

Spatial summation in nerve cells occurs because of the space constant, the ability of a charge produced in one region of the cell to spread to other regions of the cell.