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Post partum tetanus.pptx
- 1. POST PARTUM TETANUS CASE PRESENTATION
- 2. BIODATA AN an unbooked 24 yr old now P1+0 (1A) 26 days post SVD, at a TBA (her grandmother) who was referred from Igando GH to LASUTH ICU for expert care o/a tetanus. PRESENTING COMPLAINTS Neck spasms 12/7 Jaw stiffness 10/7 Recurrent upper back 2/7
- 3. HISTORY OF PRESENTING COMPLAINTS Delivered of a live female neonate via SVD at a traditional center about 26/7 Sustained a perineal tear, repaired at that center and spontaneously healed Neck spasms started about 12/7 insidous, lasting about 30secs-1min Several episodes a day, also occurs during sleep
- 4. HISTORY OF PRESENTING COMPLAINTS Jaw stiffness started 10/7 Couldn’t eat the last 3 days No difficulty in breathing, and swallowing No trauma sorethroat, ear pain, discharge Not a known seizure disorder patient
- 5. PHYSICAL EXAMINATION A young woman, opistotonus position, painful distress, afebrile, not pale, anicteric, acyanosed, mildly dehydrated, nil pedal oedema, with spontaneous spasms Dental gap 3cm CNS Conscious and alert No obv cranial deficit Neck stiffness Opistotonus posture Unprovoked and provoked spasms
- 6. EXAMINATION CONTD CVS PR 10bpm BP 112/87 mmHg CHEST RR 20cpm BS vesicular ABD Board like rigidity
- 7. ASSESSMENT AND PLAN Assessment Postpartum Tetanus Plan 1. FBC + ESR + EUCr + Serum Ca2+ + viral markers 2. NIL PER ORAL 3. Nurse in dark room 4. pass urethral catheter 5. strict input and output
- 8. PLAN CONTD 6. daily measurement of dental gap 7. keep spasm chart 8. IVF 5% DS 500mls = 5% DW 500mls + 40mg Diazepam ROCHE 4 hrly 9. IM Metronidazole 500mg 8hrly Was later placed on Augmentin, S/c clexane IV medications also changed to orals few days after
- 9. INVESTIGATIONS Full blood Count showed Anemia Normal Kidney function test Viral markers screening neg RBS 112mg/dL Abdominopelvic USS showed no sonographic abnormality
- 10. CONCLUSION Improved significantly with multi-disciplinary approach Was discharged about 1month after presentation, Subsequently referred to Neuro clinic after clinic attendance.