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12/4/11

Tetanus in Emergenc Medicine Treatment & Management

Tetanus in Emergenc Medicine Treatment & Management


Author: Daniel J Dire, MD, FACEP, FAAP, FAAEM; Chief Editor: Rick Kulkarni, MD more... Updated: Sep 20, 2011

Emergenc Department Care


Treatment of tetanus is directed toward the treatment of muscle spasm, prevention of respiratory and metabolic complications, neutralization of circulating toxin to prevent the continued spread, and elimination of the source. Admit patients to the intensive care unit (ICU). Because of the risk of reflex spasms, maintain a dark and quiet environment for the patient. Avoid unnecessary procedures and manipulations. Seriously consider prophylactic intubation in all patients with moderate-to-severe clinical manifestations. Intubation and ventilation are required in 67% of patients. Attempting endotracheal intubation may induce severe reflex laryngospasm; prepare for emergency surgical airway control. Rapid sequence intubation techniques (eg, with succinylcholine) are recommended to avoid this complication. Perform tracheostomy in patients requiring intubation for more than 10 days. Tracheostomy has also been recommended after onset of the first generalized seizure. Tetanus immune globulin (TIG) is recommended for treatment of tetanus. TIG can only help remove unbound tetanus toxin, but it cannot affect toxin bound to nerve endings. A single intramuscular dose of 3000-5000 units is generally recommended for children and adults, with part of the dose infiltrated around the wound if it can be identified. The World Health Organization recommends TIG 500 units by intramuscular injection or intravenously (depending on the available preparation) as soon as possible; in addition, administer age-appropriate TT-containing vaccine (Td, Tdap, DT, DPT, DTaP, or TT depending on age or allergies), 0.5 cc by intramuscular injection at separate site. Tetanus disease does not induce immunity; patients without a history of primary TT vaccination should receive a second dose 1 2 months after the first dose and a third dose 6-12 months later. Surgical therapy includes debridement of wounds to remove organisms and to create an aerobic environment. The current recommendation is to excise at least 2 cm of normal viable-appearing tissue around the wound margins. Incise and drain abscesses. Delay any wound manipulation until several hours after administration of antitoxin due to risk of releasing tetanospasmin into the bloodstream.

Contributor Information and Disclosures


Author Daniel J Dire, MD, FACEP, FAAP, FAAEM Clinical Professor, Department of Emergency Medicine, University of Texas Medical School at Houston; Clinical Professor, Department of Pediatrics, University of Texas Health Sciences Center San Antonio Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US Disclosure: Nothing to disclose.
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12/4/11

Tetanus in Emergenc Medicine Treatment & Management

Special Edi o Boa d Theodore J Gaeta, DO, MPH, FACEP Clinical A ocia e P ofe o , Depa men of Eme genc Medicine, Weill Co nell Medical College; Vice Chai man and P og am Di ec o of Eme genc Medicine Re idenc P og am, Depa men of Eme genc Medicine, Ne Yo k Me hodi Ho pi al; Academic Chai , Adj nc P ofe o , Depa men of Eme genc Medicine, S Geo ge' Uni e i School of Medicine Theodo e J Gae a, DO, MPH, FACEP i a membe of he follo ing medical ocie ie : Alliance fo Clinical Ed ca ion, Ame ican College of Eme genc Ph ician , Cle k hip Di ec o in Eme genc Medicine, Co ncil of Eme genc Medicine Re idenc Di ec o , Ne Yo k Academ of Medicine, and Socie fo Academic Eme genc Medicine Di clo e: No hing o di clo e. of Neb a ka Medical Cen e

Francisco Talavera, PharmD, PhD Adj nc A i an P ofe o , Uni e i College of Pha mac ; Edi o -in-Chief, Med cape D g Refe ence Di clo e: Med cape Sala Emplo men

Edd S Lang, MDCM, CCFP(EM), CSPQ A ocia e P ofe o , Senio Re ea che , Di i ion of Eme genc Medicine, Depa men of Famil Medicine, Uni e i of Calga Fac l of Medicine; A i an P ofe o , Depa men of Famil Medicine, McGill Uni e i Fac l of Medicine, Canada Edd S Lang, MDCM, CCFP(EM), CSPQ i a membe of he follo ing medical ocie ie : Ame ican College of Eme genc Ph ician , Canadian A ocia ion of Eme genc Ph ician , and Socie fo Academic Eme genc Medicine Di clo e: No hing o di clo e.

John D Halamka, MD, MS A ocia e P ofe o of Medicine, Ha a d Medical School, Be h I ael Deacone Medical Cen e ; Chief Info ma ion Office , Ca eG o p Heal hca e S em and Ha a d Medical School; A ending Ph ician, Di i ion of Eme genc Medicine, Be h I ael Deacone Medical Cen e John D Halamka, MD, MS i a membe of he follo ing medical ocie ie : Ame ican College of Eme genc Ph ician , Ame ican Medical Info ma ic A ocia ion, Phi Be a Kappa, and Socie fo Academic Eme genc Medicine Di clo e: No hing o di clo e.

Chief Edi o Rick Kulkarni, MD A ending Ph ician, Depa men of Eme genc Medicine, Camb idge Heal h Alliance, Di i ion of Eme genc Medicine, Ha a d Medical School Rick K lka ni, MD i a membe of he follo ing medical ocie ie : Alpha Omega Alpha, Ame ican Academ of Eme genc Medicine, Ame ican College of Eme genc Ph ician , Ame ican Medical A ocia ion, Ame ican Medical Info ma ic A ocia ion, Phi Be a Kappa, and Socie fo Academic Eme genc Medicine Di clo e: WebMD Sala Emplo men

Addi ional Con ib o The a ho and edi o Becke , MD.

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Tetanus in Emergenc Medicine Treatment & Management

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