RT Book, Section A1 Pitrak, David L. A1 Poston, Jason T. A1 Galaydick, Jodi A2 Hall, Jesse B. A2 Schmidt, Gregory A. A2 Kress, John P. SR Print(0) ID 1107721543 T1 Tetanus T2 Principles of Critical Care, 4e YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071738811 LK accessmedicine.mhmedical.com/content.aspx?aid=1107721543 RD 2024/10/08 AB Tetanus is caused by Clostridium tetani and is a toxin-mediated disease.Although rare in the USA, worldwide there are between 500,000 and 1 million cases a year, with over 200,000 deaths.It 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 (500-3000 IU) as early as possible.Treatment to limit continued production and absorption of toxin includes surgical debridement 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.