| ID | 232 |
|---|---|
| Name | TETANUS |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | |
| Management | Management: Prophylaxis: 1. Tetanus toxoid (T.T) 1ml i.m, boosted at 6 weeks, 6 months, then at 5 years intervals or following injury, for active immunity. 2. Passive immunity is achieved by A.T.S- 1500 units i.m. preceeded by a skin test dose of 0.2ml. Or, TIG 250 unit. 3. Proper surgical treatment & aseptic precaution. 4. A prophylactic course of penicillin. Curative: 1. Nursing of the patient in a dark and quiet room. Avoid unnecessary stimuli. 2. To neutralise absorbed toxin- i.v injection of 3000 units of human anti-tetanus globulin. 3. Tetanus toxoid is used if the patient is previously actively immunised. 4. Inj. Benzylpenicillin 600mg 6 hourly (metronidazole if allergic to penicillin). 5. Inj. Diazepam 20mg. or chlorpromazine for spasm & convulsion. 6. Infected wound is opened up, widely exised & irrigated with hydrogen peroxide & left open. 7. Maintain fluid, electrolyte balance & nutrition by a naso-gastric tube or i.v. infusion. 8. Physiotherapy is maintained 3 times daily. 9. Maintenance of respiration most important and is done by-i Tracheostomy. ii. I.P.P.V if needed. Treatment of tetanus: by staging: Treatment of establised case: 1. Isolation in quietness (best carried out in intensive care unit). 2. Wound toileting & drainage of pus (if present). 3. Anti-tetanus globulin (ATG) 2000-4000 units i.v/i.m- one dose is preferable. Stage I (Mild case): a. Tonic rigidity. b. No remarkable swallowing or respiratory difficulty. Rx. Inj. Diazepam 5-50mg i.v stat & 6 houly for sedation and relaxation. Stage II (Seriously ill): a. Swallowing difficulty (dysphagia), reflex spasm. b. No major cyanotic episode. Rx. i. Introduce nasogastric tube- 200 KCal balanced diet with 50gm protein; Or, i.v nutrition if required. ii. Sedation as above. iii. Tracheostomy if difficulty in breathing & intubation. Stage III (Dangerously ill): a. Major cyanotic convulsion. Rx. i. Stop sedatives if started before. ii. Tubocurarine chloride 20-40mg. i.v initially and later i.m to maintain relaxation, iii. IPPV must be provided untill such time so as no further muscle spasm occur, iv. These treatment to be best done in Intensive Care Unit. |
| Introduction | Tetanus is caused by Cl. tetani which multiply in deep lacerated or punctured wound contaminated with soil, containing blood clot, lacerated tissue & fragments of cloth etc. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: 1. Lock-jaw, & local muscle spasm around the wound. 2. Painful trismus produces the classical risus sardonicus. 3. Difficulty in coughing & dysphagia. Stridor, respiratory distress and failure. 4. Generalised convulsion with intervening muscle spasms. |
| Preventions | |
| Treatment | |
| Complications | Complication: 1. Severe negative nitrogen balance. 2. Myocarditis. 3. Vascular failure with extreme of blood pressure & pulse rates. 4. Severe damage to motor neurons of the cord and brain leading to major paralysis. |
| Prognosis | |
| Types | |
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| Observation | |
| Pathology |
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