Tetanus

Clinical Description

Tetanus is a nervous system disorder characterized by muscle spasms. caused by the toxin- producing anaerobe Clostridium tetani. Immunization has significantly reduced occurrence of Tetanus cases and deaths.

Signs and Symptoms

• Stiff neck
• Opisthotonus
• Risus sardonicus (sardonic smile)
• A board-like rigid abdomen
• Periods of apnea and/or upper airway obstruction due to vise-like contraction of the thoracic muscles and/or glottal or pharyngeal muscle contraction, respectively
• Dysphagia

Treatment

Adult Tetanus

• Good nursing care of the heavily sedated patient is essential
• Give active immunization against tetanus after recovery

General measures

• Nurse the patient in a dark quiet area
• Maintain adequate hydration and nutrition
• Prevent aspiration of fluid into the lungs
• Clean and debride necrotic wounds thoroughly
• Change from parenteral to oral medication as soon as possible
• Avoid provoking spasms
• Encourage active exercise after patient has recovered

Treatment

• Medical rehabilitation plays an important role in prescribing appropriate exercises.
• Give Diazepam 20 mg IM or IV Chlorpromazine 50mg IM or IV given alternately 3 hourly.

Alternatively

Give Diazepam infusion 40 mg in one liter of IV dextrose or normal saline 6-8 hourly

• Take care: respiratory depression may occur
• Dose sizes or frequencies of the above medicines can be increased if necessary to control spasms
• Give Anti-tetanus serum 20,000 units IV STAT
• Give this after a test dose of 1,500 units s/c
• Benzyl penicillin 2 MU IV 6 hourly every for 7 days
• Give Metronidazole 500 mg IV 8 hourly or 400 mg 8 hourly
• for 7 days
• Give Tetanus toxoid vaccination: give the full course