Question

. A 58-year old Native American presents in the Mercy emergency room with headache, irritability, generalized muscle pain and uncontrollable back spasms. He has become very restless and worried because he has had the back spasms all through his court case that afternoon and they became extremely painful. In his history, the patient states that he has a very busy life. He is on medication for high blood pressure (beta blocker) and has mild asthma. He injured himself about 10 days earlier, puncturing his left arm with a nail from an old barn he is tearing. The wound has produced moderate quantities of pus, but he has been keeping it clean. When asked, he did not remember having a tetanus shot since he was a kid. The wound was sampled for microscopic examination and culture. The back appears to have very tight contractions and spasms. The patient is in obvious agonizing pain. a) What is your diagnosis here? b). What is the proper treatment of this problem? c). How could this have been prevented?

Answer 1

ANSWER :

a) Diagnosis - Tetany

b)Treatment :

▪︎Tetanus immunoglobulin(TIG) :

• It provides immediate short term protection against tetanus , as it contains antibodies which kill Clostridium tetani.

▪︎Antibiotics like penicillin and metronidazole:

• Prevents multiplication of bacteria
• Prevents production of neurotoxin.

▪︎Treatment for muscle spasms :

• Muscle relaxants - Baclofen
• Anticonvulsants - Diazepam
• Muscle relaxants by neuromuscular blocking - Vecuronium , Pancuranium

▪︎Wound treatment :

• Debridement of the dead and contaminated tissue of the wound.

c) Prevention of tetany :

• Tetanus vaccine : It is given to children in combination as DTaP- Diptheria,Tetanus toxoid and acellular pertussis.
• Schedule(5 doses) : 2 , 4 , 6 , 15 - 18 mnths and 4-6 yrs of age for children.
• Booster dose given at 11- 18 yrs of age , followed by every 10 years.
• So, if he would had taken tetanus shot in childhood this could be prevented.