6/3/2023 0 Comments 5 girls 1 guy xray vision![]() This leads to the inhibition of inhibitory interneurons and allows neurons to send impulses to muscle cells, causing high-frequency, sustained muscle contractions. Once there, the toxin acts on inhibitory Renshaw interneuron cells to prevent the release of GABA and glycine. 2 The toxin goes to the end plate neuromuscular junction, where it travels retrograde to the central nervous system. 2 The spores germinate in an anerobic environment in the wound, such as necrotic tissue, where it forms exotoxin and tetanospasmin, which cause sustained muscle contractions called tetany. Infection is caused by spores entering the body through a puncture wound or other contaminated injury, especially from rusty nails. 1 The latter is caused by infection from Clostridium tetani, a gram-positive obligate anaerobe found in soil and animal feces. Tetanus was treated with intramuscular tetanus immune globulin injection of 500 units and a Tdap vaccination.ĭiscussion: There are 4 types of tetanus: generalized, local, cephalic, and neonatal, with generalized being the most common. Magnesium sulfate was given to prevent autonomic dysregulation and acetaminophen to control fever. Enoxaparin was used for deep vein thrombosis prophylaxis and IV ceftriaxone to prevent wound infection and sepsis. He was switched to intravenous (IV) metronidazole for 10 days in place of penicillin G for better tetanus coverage. The patient was given lorazepam and diazepam as needed for spasms and morphine and ketorolac for pain. He remained stable, was discharged after 9 days, and advised to follow up with his primary care physician. He continued with a normal diet and intravenous fluids and never lost bowel or bladder control. The patient never experienced laryngeal spasms. He had difficulty talking, swallowing, and taking deep breaths during full-body spasms, but his oxygen saturation never dropped. He also experienced full-body spasms upon talking, when vital signs were taken, and when he was exposed to changes in lighting. Management: The patient continued to have abdominal muscle spasms for the duration of his stay. EKG showed sinus tachycardia, and chest x-ray was unremarkable.ĭiagnosis: Given that the puncture wound was not erythematous, draining, warm, or swollen and the labs were unremarkable (ruling out sepsis, cellulitis, meningitis, and ethanol intoxication), the patient was diagnosed with generalized tetanus and hospitalized for observation. ![]() A comprehensive metabolic panel (CMP), complete blood count (CBC), lactic acid, blood culture, blood ethanol, magnesium, lipase, lactic acid reflex, prothrombin time (PT)/ international normalized ratio (INR), partial thromboplastin time (PTT), lipase, and troponin were all normal. The wound was examined and showed no evidence of cellulitis or erythema. Labs/Findings: Upon admission, patient vitals were blood pressure 145/98 mmHg, pulse 137 beats/minute, temperature 100.6 ☏, and respiratory rate 26 breaths/minute, with 100% oxygen saturation on room air. Generalized tetanus was thought to be most likely cause owing to the classic presentation. Differential Diagnosis: Tetanus, cellulitis, sepsis, meningitis, seizure activity, and ethanol intoxication were all considered as part of the differential diagnosis.
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