Date of Award
Spring 2023
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Michelle Thal
Abstract
Tetanus is rare in the United States now due to the tetanus vaccine but there is still the potential too see patients with tetanus. IV drug users, neonates, and geriatric populations are at an increased risk of developing tetanus. Tetanus is caused by Clostridium tetani, a spore forming and exotoxin releasing anaerobic bacteria. The symptoms of tetanus are caused by the exotoxin tetanospasmin which inhibits the release of inhibitory neurotransmitters, leading to sustained neuronal stimulation. The classic symptoms of tetanus are lockjaw (trismus), neck stiffness, back arching, and fever. Patients can be febrile, tachycardic, tachypneic, and hypertensive on exam. The diagnosis of tetanus is clinical. The treatment of tetanus includes neutralization of unbound toxin with human tetanus immunoglobulin, treatment of infection with metronidazole, and Tdap vaccine administration. Muscle contractions are treated benzodiazepines with diazepine being most effective and autonomic instability is treated with magnesium sulfate. Patients with tetanus should be admitted to the ICU for close monitoring because mechanical ventilation is often needed. If a healthcare provider suspects tetanus, the patient should be treated immediately to help increased chance of survival.
Recommended Citation
Paris, Nina, "Inpatient management of an intravenous drug user with tetanus" (2023). Capstone Showcase. 37.
https://scholarworks.arcadia.edu/showcase/2023/pa/37
Inpatient management of an intravenous drug user with tetanus
Tetanus is rare in the United States now due to the tetanus vaccine but there is still the potential too see patients with tetanus. IV drug users, neonates, and geriatric populations are at an increased risk of developing tetanus. Tetanus is caused by Clostridium tetani, a spore forming and exotoxin releasing anaerobic bacteria. The symptoms of tetanus are caused by the exotoxin tetanospasmin which inhibits the release of inhibitory neurotransmitters, leading to sustained neuronal stimulation. The classic symptoms of tetanus are lockjaw (trismus), neck stiffness, back arching, and fever. Patients can be febrile, tachycardic, tachypneic, and hypertensive on exam. The diagnosis of tetanus is clinical. The treatment of tetanus includes neutralization of unbound toxin with human tetanus immunoglobulin, treatment of infection with metronidazole, and Tdap vaccine administration. Muscle contractions are treated benzodiazepines with diazepine being most effective and autonomic instability is treated with magnesium sulfate. Patients with tetanus should be admitted to the ICU for close monitoring because mechanical ventilation is often needed. If a healthcare provider suspects tetanus, the patient should be treated immediately to help increased chance of survival.