RT Book, Section
A1 Gray, Perry
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Wood, Lawrence D.H.
SR Print(0)
ID 2292023
T1 Chapter 59. Tetanus
T2 Principles of Critical Care, 3e
YR 2005
FD 2005
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071416405
LK accessanesthesiology.mhmedical.com/content.aspx?aid=2292023
RD 2023/03/30
AB Tetanus  is  a  toxin-mediated  disease  caused  by  Clostridium  tetani  and  characterized  by  trismus,  dysphagia,  and  localized  muscle  rigidity  near  a  site  of  injury,  often  progressing  to  severe  generalized  muscular  spasms  complicated  by  respiratory  failure  and  cardiovascular  instability.The  diagnosis  of  tetanus  is  made  on  clinical  grounds  alone.  A  clinical  diagnosis  of  presumed  tetanus  is  sufficient  to  initiate  treatment.Patients  with  tetanus  should  be  managed  in  an  ICU.  In  severe  cases,  the  first  priority  is  control  of  the  airway  to  ensure  adequate  ventilation  and  correction  of  hypotension  related  to  hypovolemia  and/or  autonomic  instability.Antitoxin  therapy  with  human  tetanus  immune  globulin  is  given  intramuscularly  (3000  to  6000  IU)  as  early  as  possible.  In  cases  that  have  not  yet  progressed  to  generalized  spasms,  250  IU  given  intrathecally  by  lumbar  puncture  may  be  of  benefit.Treatment  to  limit  continued  production  and  absorption  of  toxin  includes  surgical  débridement  of  the  site  of  injury  and  antimicrobial  therapy  with  intravenous  metronidazole.Traditionally  muscle  rigidity  and  spasms  have  been  treated  with  high-dose  benzodiazepines  and  narcotics.  However,  intravenous  magnesium  therapy  should  also  be  considered.Cardiovascular  instability  due  to  autonomic  dysfunction  is  managed  by  ensuring  normovolemia  and  using  benzodiazepine,  narcotic,  and/or  magnesium  sulfate  infusions  when  needed.Supportive  measures  include  early  provision  of  nutrition,  correction  of  electrolyte  disturbances,  subcutaneous  heparin  administration  for  prophylaxis  of  deep  venous  thrombosis,  and  prompt  antimicrobial  therapy  for  nosocomial  infection.With  meticulous  management  of  the  manifestations  of  this  disease  and  careful  attention  to  prevention  of  its  major  complications,  complete  recovery  is  possible  in  most  cases.