2. • Tetanus is an acute, toxin-mediated disease
caused by Clostridium tetani. Characterized by
an acute neuromuscular impairment such as
trismus, stiffness and muscle spasms.
7. Management
ABC! (may need tracheostomy and ventilation)
• Human tetanus immunoglobulin (HTIG) 150 units/kg IM
• Diazepam 5–20mg/8h PO or 0.05–0.2mg/kg/h IVI (≤140mg/d)
S.Phenobarbital 1.0mg/kg/h IM or IV + chlorpromazine
S.0.5mg/kg/6h IM
FAILS? paralyse and ventilate (get anaesthetist’s help).
• Metronidazole, eg 500mg/6h PO for 7d
8. Prevention
Open injuries have a potential for serious
bacterial wound infections including tetanus
Wash the wounds debridement leave the wound open prophylaxis
there is no natural immunity against tetanus
protection can be provided TT or TIG
9.
10. • Antibiotic prophylaxis is indicated in situations or wounds at
high risk to become infected
• Recommended prophylaxis consists of penicillin G and
metronidazole given once (more than once if the surgical
procedure is > 6 hours).
- Penicillin G ADULT: IV 8-12 million IU once.
CHILD: IV 200,000 IU/kg once.
- Metronidazole ADULT: IV 1,500 mg once (over 30min)
CHILD: IV 20 mg/kg once.
Editor's Notes
Eksitasi NTR: ASPARTAT DAN GLUTAMAT
Stiffness of facialmuscles produces risus sardonicus
paraspinal rigidity can produce opisthotonus.
Superimposed paroxysmal painful tonic spasms (tetanospasms) occur spontaneously or are
triggered by tactile stimuli or sound.
Pharyngeal muscle Spasm causes dysphagia, and laryngeal and respiratory muscle
spasms cause asphyxia.
Autonomic dysfunction can cause fever, blood pressure swings, severe diaphoresis, and cardiac arrhythmia even when body spasms are controlled
ABC! (may need tracheostomy and ventilation)
BP + SpO2 (keep >92%, eg with O2 mask + reservoir);
careful fluid balance.
• Human tetanus immunoglobulin (HTIG) 150 units/kg IM at multiple sites to neutralize toxin.
• Aim to keep the patient asleep but rousable to obey simple requests.
Diazepam 5–20mg/8h PO (mild disease; much higher doses may be needed, eg 480mg/d)or, to control spasms, 0.05–0.2mg/kg/h IVI (≤140mg/d) or phenobarbital 1.0mg/kg/h IM or IV + chlorpromazine 0.5mg/kg/6h IM (IV bolus is dangerous) starting 3h after the phenobarbital. If this fails to control the spasms, paralyse and ventilate (get anaesthetist’s help). (KURARISASI)
Dose example: pancuronium 2–4mg IV, then 1–2mg/h by IVI if needed
• Metronidazole, eg 500mg/6h PO for 7d (?better than benzylpenicillin 1.2g/4h IV).
Kalo mau pake ATS 20.000IU/HARU selama 5hari straight
HTIG cukup sekali karna wajtu paruh 3 1/2-4 1/2 minggu
DPT
2 4 6 2Y 5Y 10Y 18Y BOSTER 10Y
high risk to become infected
contaminated wounds, penetrating wounds, abdominal trauma, compound fractures, lacerations greater
than 5 cm, wounds with devitalized tissue, high risk anatomical sites such as hand or foot. etc.
