Severe, intractable spasms with autonomic instability (it is the autonomic dysfunction that kills them).
Contaminated wound esp if the patient never received the tetanus series: old folks and immigrants are at high risk.
C. tetani. A spore former they exist forever in the environment.
Found in soil and gi tracts.
Clostridia tetani: tetanus aka lock jaw. Treatment: C. tetani: Human tetanus immune globulin (HTIG) 500 IU.
Patient will require intubation /tracheostomy and neuromuscular blockade to prevent spasms. A benzodiazepine intravenously (diazepam in 5-mg increments, or lorazepam in 2-mg increments) to control spasm and decrease rigidity. Transfer the patient to a quiet, dark room as external stimuli can set off spasms.
Débride any wounds. Treat sympathetic hyperactivity with labetalol (0.25-1.0 mg/min as needed for blood pressure control) or morphine (0.5-1.0 mg/kg/hr by continuous infusion; bradycardia may require a pacemaker.
High-dose intravenous Mg may help the tetany, keep levels between 3 and 4 mmol/l (Ref).
PearlsEven after tetanus, they still need the vaccine series; the disease is not enough to cause immunity.
ICD9 Codes (Soon to be supplanted by ICD10)
Tetanus, tetanic (cephalic) (convulsions) 037; abortion 639.0; inoculation V03.7.