Tetanus
David Gelbart, MMS, PA-C
• Caused by inoculation of the bacteria Clostridium tetani t Trismus leads to poor feeding
° Bacteria is found in soil and animal feces (flora of the • Incubation period is variable (2 to 38 days)
mammalian gut) ° Mean incubation period is 7 to 10 days postexposure
° Gram-positive, spore-forming anaerobe that produces ° Longer incubation for inoculation sites more distal to
David Gelbart is a medical student at Lake Erie College of Osteopathic a. IV drug use
Medicine and a PA in emergency medicine. The author has disclosed b. unprotected sexual intercourse
no potential conflicts of interest, financial or otherwise.
c. ingestion of undercooked meat
Dawn Colomb-Lippa, MHS, PA-C, department editor
DOI:10.1097/01.JAA.0000526785.27024.bb d. ingestion of contaminated water
Copyright © 2017 American Academy of Physician Assistants
deep vein thrombosis prophylaxis ° Should be administered to women during every preg-
g/h continuously for patients weighing 45 kg (99 lb) sexual intercourse, or contaminated food or water.
or more, or 1.5 g/h continuously for patients weighing central nervous system. Tetanus is not contracted through
less than 45 kg allow C. tetani access to the body and ultimately to the
• Human tetanus immune globulin (HTIG) to neutralize layers of the skin, including punctures from needles, may
unbound toxin 2. A. Any compromise in the structural integrity of the protective
• Wound debridement to eradicate spores at inoculation manifestation of DVT; neither involve tetanus.
site of meningeal irritation and Homan sign is a clinical
• Antibiotics: metronidazole is first-line, penicillin is second- mediated allergy. Kernig sign is a clinical manifestation
line urticaria, which is a cutaneous manifestation of IgE-
° Metronidazole 500 mg IV every 6-8 hours for 7-10 tachycardia. Tetanus would be an unlikely source of
days 1. B. Tetanus may cause autonomic instability leading to
° Penicillin G, 2-4 million units IV every 4-6 hours for