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at risk patients

  • those who have never been vaccinated or vaccination course incomplete or > 10 years ago who have a tetanus prone wound such as:
    • retained foreign body esp. wood
    • contaminated wound
    • compound fracture
    • extensive wound eg. burns
  • in particular:
    • neonates as non vaccinated - high risk with cutting umbilical cord with non-sterile tools (eg. glass)
    • elderly
    • born overseas in countries where vaccination rates are low

general prophylaxis for high risk patients

  • tetanus immunoglobulin within 72hrs to cover immediate risk
  • tetanus vaccination in opposite limb to cover the period after immunoglobulin effect wanes and to prevent future episodes

Rx of established tetanus

  • supportive ICU care with intubation and Rx as below decreases mortality from 90% to around 10%
  • iv or PR metronidazole (PR has higher CNS concentrations as bypasses 1st pass effect)
    • NB. penicillin is NO LONGER recommended as 1st line as it increases GABA release in CNS and increases muscle spasms
  • immunoglobulins decrease duration
  • anti-spasmodics
  • etc.
tetanus.txt · Last modified: 2022/07/02 23:51 by gary1

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