0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22
Tetanus 1413■May have fever
■In severe cases, autonomic dysfunction may occurtests
■Basic Tests: Blood. May have increased WBC, May have increased
CPK, normal calcium
■Basic Tests, other: may have urine myoglobin
■Specific Diagnostic Tests: Diagnosis is clinical. Serum antitoxin level
of 0.01 units/ml is usually protective, but doesn’t rule out the diag-
nosis.
■Other Tests: Cerebrospinal fluid is normal
■Toxicology for strychnine is negative.differential diagnosis
■Strychnine poisoning, hypocalcemia, rabies, dystonic reaction,
meningitis/encephalitis. Trismus can also be caused by alveolar
abscess.management
What to Do First
■Assess airway and ventilation-upper airway can be obstructed or
diaphragm can be involved by spasms. May require intubation with
early tracheostomy.
■Draw labs
■Given tetanus immune globulin and dT at separate sites.
■ICU monitoring and care
■Clean and debride wound.General Measures
■Antispasmodics: Benzodiazepines do not oversedate or depress res-
piratory function.
■Minimize paralysis duration to avoid prolonged paralysis.
➣Use non-depolarizing paralytic: consider propofol, dantrolene,
baclofen
➣Treat autonomic dysfunction, which usually occurs several days
after onset of symptoms, with drips if labile (labetalol, esmolol).specific therapy
Indications
■Antibiotics of unproven efficacy but often used.
■Antitoxin neutralizes circulating toxin and unbound toxin in wound,
lowering mortality.