, analyzing 150 cases of tetanus, reported that intensivecare, proper nutrition, early tracheostomy and ventilator support insevere tetanus were chiefly responsible for an overall reduction inmortality from 30 to 12% while the mortality in severe tetanus wasreduced from 70 to 23%
. Both studies reported cardiac abnormalitydue to autonomic dysfunction as major cause of mortality, instead of respiratory failure which has been predominant cause of mortalityprior to use of intensive care practices in management of tetanus.The aspects which should be considered while managing a patientwith tetanus are:
Specific treatment, which includes wound management,antibiotic therapy, neutralization of unbound toxin, control of muscle spasms, management of autonomic instability,
Prevention of early complications
The diagnosis of tetanus is primarily clinical with laboratoryinvestigations being virtually of no use. History of injury, or presenceof a wound aids in strengthening the diagnosis. Clinical diagnosisrequires high index of suspicion especially in areas with lower incidence of disease.Tetanus follows an injury with a median
of 7days; 15% of cases occur with in 3 days and 10% after 14 days. In15 to 30% of patients, where the portal of entry is not evident, acareful search for signs of parentral drug abuse, otitis media,instrumentation like septic abortion, injections or minor surgicalprocedures should be inquired.