A 67-year-old female has presented acutely with a diagnosis of tetanus. She sustained a laceration one week earlier while gardening and has now developed generalised spasms and respiratory distress.
Outline your specific management of this patient including management of the anticipated complications of tetanus.
This case is consistent with a diagnosis of severe generalized tetanus.
Neutralisation of unbound toxin
Source control and limitation of toxin production
Control of spasms
Management of autonomic dysfunction
Initiation of full active tetanus immunization (with diphtheria and pertussis) given at site separate from TIG injection.
Management of tetanus:
This question would have killed most people.
Oh well. One approaches this as any other "outline your management" question.
A more generic discussion of tetanus is carried out in the Required Reading section.
Rodrigo, Chaturaka, Deepika Fernando, and Senaka Rajapakse. "Pharmacological management of tetanus; an evidence based review." Crit Care18 (2014): 217.
Cook, T. M., R. T. Protheroe, and J. M. Handel. "Tetanus: a review of the literature." British Journal of Anaesthesia 87.3 (2001): 477-487.
Wesley, A. G., et al. "Labetalol in tetanus." Anaesthesia 38.3 (1983): 243-249.
Attygalle, D., and N. Rodrigo. "Magnesium as first line therapy in the management of tetanus: a prospective study of 40 patients*." Anaesthesia 57.8 (2002): 778-817.