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A 23 y/o M demonstrating severe face and arm muscle spasms. Lab tests show…

- - - - The needles had been in contact with the bacterium Clostridium tetani
        
        The needles punctured the skin and Clostridium tetani was able to destroy muscle tissue and enter the bloodstream
        
        Since the bacterium is anaerobic it thrived in the body and was able to travel and grow
        
        It then disrupted the nervous system which disrupted the muscular system causing the twitches
  - - - This is what causes the patient to experience the muscle spasms rather than paralysis
- - - - This process is what triggers muscle contraction
        
        There are six steps to the events that occur at this junction
        
        ACh diffuses across the synaptic cleft
        
        It then binds to the ACh receptors on the sarcolemma
        
        Voltage gated Ca channels open
        
        Calcium enters the axon terminal moving down its electromechanical gradient
        
        Chemically gated ion ion channels open
        
        ACh binding allows chemically gated ion channels to open
        
        This allows the NaK pump to flow causing a local change in the membrane potential
        
        The action potential arrives
        
        AP arrives at the axon terminal of motor neuron
        
        ACh effects are terminated
        
        ACh breaks down in the synaptic cleft by acetylcholinerase and diffuses away from the junction
        
        ACh is released
        
        Steps of exocytosis
        
        ACh is stored at the ends of neurons
        
        When calcium enters ACh is released
        
        During exocytosis vesicles push through the cell membrane filled with ACh and can travel freely
        
        The calcium entry causes Ach to be released by exocytosis
  - - - This system consists of the brain, spinal cord, and nerves
        
        It acts as the control center of the brain and responds to internal and external stimuli
    - - This system consists of the muscles of the body
        
        Its function is to allow movement, maintain posture, and produce heat
    - - This system consists of the hair skin and nails
        
        It's function is to protect deeper tissues from injury, synthesize vitamin D, and house glands
    - - The immune system functions to attack and protect against foreign substances in the body
  - - - ACh is released by all neurons that stimulate skeletal muscles
      - ACh is synthesized from acetic acid and choline
        
        This is done by the the enzyme choline acetyltransferase
      - It gets transported into synaptic vessels to be released
        
        Once released it temporarily binds to postsynaptic receptors
        
        It is then broken down by acetlycholinerase
  - - - The spores are highly resistant. (Can survive boiling and household disinfectants)
        
        In wounds the spores will germinate
        
        The spore produce two main toxins
        
        Tetanospasmin
        
        This is a neurotoxin that causes the muscle spasms and other tetanus related symptoms
        
        It prevents the release of inhibitory neurotransmitters
        
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        Tetanolysin
        
        This toxin amplifies the affect of tetanospasmin
        
        It damages local muscle tissues to allow room for bacterial growth
        
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        Germinate: grow
  - - - There are two types of tetany
        
        Unfused tetanus
        
        This is a result of the wave of summation becoming greater and greater progressing to a sustained quivering contraction
        
        Fused tetanus
        
        When the stimulation frequency reaches maximum tension
        
        The contractions fuses into a smooth sustained contraction plateau
    - - Summation occurs when two or more identical stimuli are delivered in succession
        
        Here the second contraction begins before the muscle relaxes
        
        The second contraction is usually greater than the first and the refractory period is always honored
        
        Purpose of this is to produce smooth continuous muscle contractions
    - - A muscle twitch happens as result of a muscle being stimulated
        
        There are three periods of muscle twitching
        
        Period of contraction
        
        Cross bridges are active here through the peak of tension
        
        Period of relaxation
        
        Here muscle tension decreases to zero and calcium is pumped back into the SR
        
        The latent period
        
        This is the first few milliseconds following stimulation
        
        This is when excitation-contraction is occurring
        
        Muscle tension isn't measurable here
- - - - The toxin tetanospasmin causing the muscles to constantly contract affects respiratory muscles as well
        
        Without being stabilized the patient an experience hypoxia and die
        
        Hypoxia is a condition that occurs when there's not enough oxygen reaching the tissues and organs
        
        Without proper oxygenation the body will experience tissue damage and organ failure
      - The uncontrolled tightening of the vocal cords could also occur
        
        Laryngospasms
      - The muscles could continue to tighten at inappropriate times possibly causing the bones to break
    - - If the infection spreads to the brain it can cause seizures
    - - The toxins spread throughout the body quickly and the body's immune response isn't able to fight it off quickly
    - - The skin was penetrated by the needle infecting all of the layers of the epidermis and the dermis
        
        If untreated, the wounds on the surface of the skin will continue to fester