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• W4387248844 abstract "SESSION TITLE: Critical Care Case Report Posters 31 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Tetanus is a reportable, highly preventable disease in current times, with the number of cases down significantly to over 99% in the US since 1947 (per Centers for Disease Control and Prevention). With the current rare number of cases per year, guidelines for management of tetanus are often broad and ill-defined. We would like to report a rare case of generalized tetanus and the successful management of severe spasms. CASE PRESENTATION: An unvaccinated 33-year-old male presented to our ER with left foot spasms that quickly spread to the calf, followed by generalized spasms and opisthotonos. He stepped on a dirty nail a week prior. He received early administration of tetanus Ig, tetanus vaccine and metronidazole. Regardless of the presence of lockjaw, early intubation is crucial, given the sedating agents and pain regimen required to treat tetany. He was intubated successfully with difficult airway precautions. Diazepam was started early on, in addition to versed and propofol drips, magnesium drip, phenobarbital, and cyproheptadine for severe spasm control. Vitamin D and calcium repletion were imperative. Pain was managed with fentanyl drip, rescue doses of hydromorphone then transitioned to opiates via oral gastric tube. He clinically improved, required tracheostomy and feeding tube placement. After 34 days in the ICU, he was transferred to a long term care facility for severe deconditioning and vent weaning. He was able to tolerate trach collar trials and physical therapy at time of discharge. DISCUSSION: Tetanus is generally seen in unvaccinated individuals and can be a highly debilitating disease with associated death rate of 10-20% in generalized tetanus despite modern intensive care. There are three clinical forms: generalized, localized, and cephalic. The incubation period is on average 7 days, but it can range from 3 to 21 days. Once the neurotoxin binds to nerve terminals it is irreversible, and the body is dependent on its own ability to regenerate new nerve terminals. Muscle spasm and spastic paralysis are seen due to unchecked motor neurons firing, given neuron inability to release inhibitory neurotransmitters. Thus, it is imperative to administer tetanus immunoglobulin to these patients as early as possible. In our patient, his spasms started locally but quickly became generalized and stopped progressing further soon after immunoglobulin administration. The rest of his management was focused on controlling his spasms and protecting his airway. CONCLUSIONS: This case highlights the importance of vaccination, early administration of immunoglobulin, metronidazole, and to recognize the regimen for severe spasm control. REFERENCE #1: Centers for Disease Control and Prevention. (2022, August 29). Tetanus: For Clinicians. Centers for Disease Control and Prevention. Retrieved March 29, 2023, from https://www.cdc.gov/tetanus/clinicians.html REFERENCE #2: Sah, S. P., Khanal, S., Dahal, S., Shrestha, A., & Pradhan, B. (2022). Generalized tetanus in an elderly patient: A case report. Annals of Medicine & Surgery, 81. https://doi.org/10.1016/j.amsu.2022.104465 REFERENCE #3: Thwaites, L. (n.d.). Tetanus. UpToDate. Retrieved March 29, 2023, from https://www.uptodate.com/contents/tetanus DISCLOSURES: No relevant relationships by Ma Theresa Bautista No relevant relationships by Natalie Kandinata" @default.
• W4387248844 created "2023-10-03" @default.
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• W4387248844 date "2023-10-01" @default.
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• W4387248844 title "SUCCESSFUL MANAGEMENT OF SEVERE SPASMS WITH OPISTHOTONOS IN ADULT MALE TETANUS" @default.
• W4387248844 doi "https://doi.org/10.1016/j.chest.2023.07.1325" @default.
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