MANAGEMENT OF TETANUS IN ICU : A LOCAL EXPERIENCE. Medical Intensive Care Unit PIMs Dr.Rubina Aman MRCP(UK) Dr.Hashim Husnain FCPS 2(Resident). INTRODUCTION. A nervous system disorder characterized by painful muscle spasms.
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Medical Intensive Care Unit
Dr.Rubina Aman MRCP(UK)
Dr.Hashim Husnain FCPS 2(Resident)
MEAN Age: 36 Yrs
Period between exposure to the Micro organism and manifestation of disease
43 cases per year in US.(1)
3 cases in 1997.
2 cases in 1998 in Canada(2)
1) Pascal, FB Tetanus surveillance in US1998 –2000 Surveill Summ 2003;52:1
2) Report of the public health agency of Canada 2000.
Report of Public Health agency of Canada.Vaccine preventable diseases
56% 2002 , 57% 2003, 45% 2004 (3)
(3) Knowledge and attitude of reproductive age females about tetanus toxoid vaccine: Amna Zeb JCPS2006,vol 16(12)
27 oct 20005 associate press.
144 tetanus cases including 41 dead;
Consolidated health situation bulletin #3 . 8 Nov.2005
M Bulut, R Fedakar, Emergency Med J 2005 ; 22:494-498
“All patients received Tetanus prophylaxis.There was no case of gas gangrene or tetanus”
4) Miranda-Filho, B,Ximenes. Randomized controlled trial of tetanus treatment with antitetanus immunoglobulin by intrathecal or intramuscular route. BMJ2004;328:615
5) Ahmed shah.Br Med J 1985;291:648.
6) Yen,LM Management of tetanus: Symposium of anti microbial resistance in Southern VietNam, 1997.
7) Daniel J Dire: Update on tetanus Dec1 2006.
9) MH Trujillo,Acastillo. Impact of intensive care management on prognosis of tetanus. An analysis of 641 cases. Chest 1987;92;63-65
9) Attygalle D, Rodrigo. Magnesium as first line therapy in the management of tetanus: Anesthesia 2002;57;811
Comparison of mortality before and after ICU
335 before ICU (1956 -68) Mortality 43%
306 after ICU(1968- 84) Mortality 15%(10)
126 before ICU (1981-93) Mortality 36.5%
110 after ICU (1993-2001) Mortality 18%(11)
10) MH Trujillo, Alferd Castillo Impact of Intensive care Management on prognosis of tetanus. Chest 92-1/July 1987.
11) Brauner JS, Viera SR. Changes in severe accidental tetanus mortality in ICU during two decades in Brazil. Intensive care med; 28(7):930-5.2002 Jul
12) Orellana- san Martin C et al,Tetanus in Intensive Care units .Rev Neurol.2003 Feb 15-28;36(4):327-30
13) Fernandez-Mena Tetanus Disease: Our ICU statistics at Utama Gen Hosp 1998-2002. Neurology 2004.vol 2 no.2