MANAGEMENT OF TETANUS

Abstract

The most important objectives in the management of tetanus are: (1) neutralization of free toxin with tetanus antitoxin; (2) elimination of the source of toxin by débridement of all accessible portals of entry or by administration of antibiotics; (3) prevention of convulsions and severe muscle spasms by use of sedatives, anesthetics, or such muscle relaxants as curare preparations and, preferably, mephenesin; (4) maintenance of efficient hydration and of electrolyte balance; (5) maintenance of proper nutrition, and (6) prevention and treatment of pulmonary complications through maintenance of unobstructed air passages by mechanical means and by administration of antibiotics. Most observers¹ agree that 50,000 units of tetanus antitoxin given intravenously is a dose large enough to neutralize all the unfixed or free toxin in any patient with a chance of recovery. Since it is impossible to ascertain whether fixation of the toxin by the cells of the central nervous system is